Towards screening Barrett’s oesophagus: current guidelines, imaging modalities and future developments

Abstract

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials.

Current state of prognostication, therapy and prospective innovations for Barrett’s-related esophageal adenocarcinoma: a literature review

“…P53 staining of LGD tissue can be helpful in defining risk of HGD and EAC development along with inspection of the loss of heterozygosity (LOH) of the gene (77). LOH in the tumor suppressor P53 has been observed in both EAC and HGD tissue resulting in a 16-fold increase in the risk of developing EAC (76).…”

“…LOH in the tumor suppressor P53 has been observed in both EAC and HGD tissue resulting in a 16-fold increase in the risk of developing EAC (76). One study found that the mutated gene was found in 72% of EAC cases and 69% of LGD cases, but only in 2.5% of non-dysplastic cases (77). While this could serve as an effective biomarker for EAC progression risk, a conflicting study found that 32.7% of BE patients with this type of P53 LOH behavior progressed to EAC (78).…”

“…IHC has been used in diagnostic, predictive and prognostic BE applications. IHC of TFF3 has been used to screen patients for BE, as well as on P21, P53, and ERCC1 to predict a patient's potential response to chemotherapy (77). IHC analysis of EGFR, Cyclin A, and Cyclin D1 have also been used in a predictive manner (77).…”

“…IHC of TFF3 has been used to screen patients for BE, as well as on P21, P53, and ERCC1 to predict a patient's potential response to chemotherapy (77). IHC analysis of EGFR, Cyclin A, and Cyclin D1 have also been used in a predictive manner (77). Biomarkers for prognostic endpoints have also been investigated using IHC, with markers such as Cyclin D1 and EGFR indicating decreased survival, and COX-2 and VEGF being associated with metastases, recurrence or shorter survival (77).…”

“…IHC analysis of EGFR, Cyclin A, and Cyclin D1 have also been used in a predictive manner (77). Biomarkers for prognostic endpoints have also been investigated using IHC, with markers such as Cyclin D1 and EGFR indicating decreased survival, and COX-2 and VEGF being associated with metastases, recurrence or shorter survival (77). IHC has also been used to identify EPCAM as a potential EAC-specific biomarker, which could be useful as a BE progression risk marker (80).…”