Screening and surveillance for Barrett’s esophagus

Abstract

The incidence of esophageal adenocarcinoma, a tumor associated with gastroesophageal reflux disease and Barrett's esophagus, has increased more than sixfold over the past several decades in the United States. To decrease deaths from this cancer, some authorities have recommended endoscopic screening and surveillance for Barrett's esophagus. Opponents of these expensive and potentially harmful practices argue that screening and surveillance should not be endorsed without proof of efficacy. Proponents argue that proof of efficacy is unlikely to be available in the foreseeable future, and that the rationale for screening and surveillance is sound and supported by numerous observational studies and computer models. The bulk of the indirect evidence available suggests that screening and surveillance are beneficial, and despite the major objections focusing on financial concerns, per-r r forming unnecessary screening and surveillance seems preferable to missing curable esophageal neoplasms.