Are screening and surveillance for Barrett's oesophagus really worthwhile?

Area of Science:

• Gastroenterology
• Oncology

Background:

• Oesophageal adenocarcinoma incidence is increasing.
• Barrett's oesophagus, a complication of gastro-oesophageal reflux disease, is the sole known precursor.
• Barrett's oesophagus is often asymptomatic and undiagnosed.

Purpose of the Study:

• To review the current evidence for screening and surveillance of Barrett's oesophagus and oesophageal adenocarcinoma.
• To discuss the potential benefits and limitations of current screening practices.
• To highlight areas for future research in cost-effectiveness and diagnostic tools.

Main Methods:

• Literature review of existing studies on oesophageal adenocarcinoma and Barrett's oesophagus.
• Analysis of current screening and surveillance practices.
• Discussion of indirect evidence and the need for prospective trials.

Main Results:

• No direct data support general population screening for Barrett's oesophagus or oesophageal adenocarcinoma.
• Indirect evidence suggests potential benefits of early detection in high-risk groups.
• Cost-effectiveness of surveillance programs requires further assessment.

Conclusions:

• Screening endoscopy may be justifiable in high-risk populations for early cancer detection.
• Improved diagnostic tools and identification of high-risk groups are crucial.
• Prospective studies are needed to evaluate the cost-effectiveness of surveillance programs.