J Neurogastroenterol Motil 2019; 25(2): 181-188  
Screening for Barrett’s Esophagus: Balancing Clinical Value and Cost-effectiveness
Amit Patel1* and C Prakash Gyawali2
1Division of Gastroenterology, Duke University School of Medicine, and the Durham Veterans Affairs Medical Center, Durham, NC, USA; and 2Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
Correspondence to: *Amit Patel, MD
Division of Gastroenterology, Duke University School of Medicine, 10207 Cerny St, Suite 210, Raleigh, NC 27617, USA, Tel: +1-919-684-1816, Fax: +1-919-479-2664, E-mail: amit.patel@duke.edu
Received: September 13, 2018; Revised: November 25, 2018; Accepted: December 8, 2018; Published online: April 30, 2019.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
In predisposed individuals with long standing gastroesophageal reflux disease (GERD), esophageal squamous mucosa can transform into columnar mucosa with intestinal metaplasia, commonly called Barrett’s esophagus (BE). Barrett’s mucosa can develop dysplasia, which can be a precursor for esophageal adenocarcinoma (EAC). However, most EAC cases are identified when esophageal symptoms develop, without prior BE or GERD diagnoses. While several gastrointestinal societies have published BE screening guidelines, these vary, and many recommendations are not based on high quality evidence. These guidelines are concordant in recommending targeted screening of predisposed individuals (eg, long standing GERD symptoms with age > 50 years, male sex, Caucasian race, obesity, and family history of BE or EAC), and against population based screening, or screening of GERD patients without risk factors. Targeted endoscopic screening programs provide earlier diagnosis of high grade dysplasia and EAC, and offer potential for endoscopic therapy, which can improve prognosis and outcome. On the other hand, endoscopic screening of the general population, unselected GERD patients, patients with significant comorbidities or patients with limited life expectancy is not cost-effective. New screening modalities, some of which do not require endoscopy, have the potential to reduce costs and expand access to screening for BE.
Keywords: Adenocarcinoma of esophagus; Barrett’s esophagus; Gastroesophageal reflux


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