Esophageal cancer screening, early detection and treatment: Current insights and future directions

Table 1 Geographical variations in esophageal cancer screening

Country	Governmental/healthcare policies	Definition of high-risk groups	Screening strategies
China	China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing)[26]	(1) Age ≥ 40 yr from areas with high prevalence of esophageal tumors; (2) Family history of esophageal tumors; and (3) Risk factors for esophageal cancer (smoking, heavy alcohol consumption, squamous carcinoma of the head and neck or respiratory tract, preference for high-temperature and preserved foods, poor oral hygiene, etc)	Endoscopic screening: (1) High-risk groups: endoscopic screening with iodine staining of the esophageal mucosa is recommended (45 yr ≤ age ≤ 75 yr, every 5 yr); (2) Low-grade intraepithelial neoplasia every 1-3 yr; (3) Low-grade intraepithelial neoplasia combined with endoscopic risk factors or lesions > 1 cm in length will undergo endoscopy once a year for 5 yr; (4) Endoscopy is recommended every 3 to 5 yr for patients with Barrett's esophagus without atypical hyperplasia; (5) Endoscopy is recommended every 1 to 3 yr for Barrett's esophagus patients with low-grade intraepithelial neoplasia; (6) A new type of esophageal cell collector is recommended for Barrett esophageal screening; (7) The new esophageal cell collector (Cytosponge) performs cytological examination combined with biomarker detection for effective primary screening of Barrett's esophagus-related dysplasia and early esophageal adenocarcinoma; and (8) Biomarker testing alone not recommended for esophageal cancer screening. Equipment: Lugol color endoscopy or NBI endoscopy is recommended as the first choice for esophageal cancer screening, ordinary white light endoscopy can be chosen for those with insufficient conditions, and magnifying endoscopy can be used in conjunction with NBI endoscopy for those with conditions
American	ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus[21]	(1) Male; (2) More than 5 yr or frequent (at least once per week) symptoms of gastroesophageal reflux disease; and (3) ≥ 2 risk factors for Barrett's esophagus or esophageal adenocarcinoma, risk factors including age > 50 yr, Caucasian ethnicity, centripetal obesity (waist circumference > 102 cm or waist-to-hip ratio > 0.9), history of smoking, and history of first-degree relatives with Barrett's esophagus or esophageal adenocarcinoma	(1) Unsedated transnasal endoscopy can be considered as an alternative to conventional upper endoscopy for Barrett's esophagus screening; (2) For BE patients without dysplasia, endoscopic surveillance should take place at intervals of 3 to 5 yr; and (3) Use of additional biomarkers for risk stratifi cation of patients with Barrett's esophagus is currently not recommended. Equipment: Surveillance should be performed with high-defi nition/high-resolution white light endoscopy
United Kingdom	British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus[18]	(1) White male; (2) Age > 50 yr; (3) Obese; (4) Chronic GERD symptoms for more than 3 yr; and (5) First-degree relative with history of Barrett's esophagus or esophageal adenocarcinoma years	(1) Endoscopic screening can be considered in patients with chronic GERD symptoms and multiple risk factors (at least three of age 50 yr or older, white race, male sex, obesity). However, the threshold of multiple risk factors should be lowered in the presence of family history including at least one first-degree relative with Barrett’s or OAC; (2) High-resolution endoscopy should be used in Barrett’s oesophagus surveillance; (3) Patients with Barrett’s oesophagus shorter than 3 cm, with IM, should receive endoscopic surveillance every 3-5 yr; (4) Patients with segments of 3 cm or longer should receive surveillance every 2-3 yr; and (5) Biomarker panels cannot yet be recommended as routine of screening

NBI: Narrow band imaging; GERD: Gastroesophageal reflux disease; OAC: Oesophageal adenocarcinoma.