New Approaches to Screening for Barrett Esophagus

Current screening methods for Barrett esophagus (BE), the precursor to esophageal adenocarcinoma (EAC), are inadequate with less than one-third of screen-eligible patients currently undergoing screening. In addition to low screening rates, key issues include overemphasis on gastroesophageal reflux disease symptoms and lack of provider awareness, owing in part to heterogeneous guidelines. To address these challenges, several new approaches are being explored: swallowable cell collection devices, exhaled volatile organic compounds analysis, blood-based molecular biomarkers, microbiome analysis, and alternative visualization methods such as transnasal and capsule endos-copy. Proposed strategies to improve BE screening integrate enhanced risk stratification tools using machine learning and electronic health record data, noninvasive screening for low-risk patients, traditional endoscopy for high-risk patients, primary care education, and public health initiatives to increase awareness. This article highlights the latest developments in BE detection, including noninvasive screening methods and strategies to improve risk stratification, that have the potential to reduce EAC incidence and mortality.