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World J Gastroenterol. Aug 28, 2022; 28(32): 4516-4526
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4516
Expanding beyond endoscopy: A review of non-invasive modalities in Barrett’s esophagus screening and surveillance
Dariush Shahsavari, Praneeth Kudaravalli, John Erikson L Yap, Kenneth J Vega
Dariush Shahsavari, Praneeth Kudaravalli, John Erikson L Yap, Kenneth J Vega, Division of Gastroenterology and Hepatology, Augusta University-Medical College of Georgia, Augusta, GA 30912, United States
Author contributions: Shahsavari D performed the majority of the writing and prepared tables, Kudaravalli P contributed to writing and prepared figures; Yap JEL provided input in writing the paper; Vega KJ designed the outline, coordinated the writing of the paper, edited the paper for intellectual content and is the guarantor.
Conflict-of-interest statement: No conflict of interest exists for any author of this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kenneth J Vega, AGAF, FACG, FACP, MD, Professor, Division of Gastroenterology and Hepatology, Augusta University-Medical College of Georgia, 1120 15th Street AD 2226, Augusta, GA 30912, United States. kvega@augusta.edu
Received: January 14, 2022
Peer-review started: January 14, 2022
First decision: April 12, 2022
Revised: May 14, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: August 28, 2022
Abstract

Barrett’s esophagus (BE) is a condition that results from replacement of the damaged normal squamous esophageal mucosa to intestinal columnar mucosa and is the most significant predisposing factor for development of esophageal adenocarcinoma. Current guidelines recommend endoscopic evaluation for screening and surveillance based on various risk factors which has limitations such as invasiveness, availability of a trained specialist, patient logistics and cost. Trans-nasal endoscopy is a less invasive modality but still has similar limitations such as limited availability of trained specialist and costs. Non-endoscopic modalities, in comparison, require minimal intervention, can be done in an office visit and has the potential to be a more ideal choice for mass public screening and surveillance, particularly in patents at low risk for BE. These include newer generations of esophageal capsule endoscopy which provides direct visualization of BE, and tethered capsule endomicroscopy which can obtain high-resolution images of the esophagus. Various cell collection devices coupled with biomarkers have been used for BE screening. Cytosponge, in combination with TFF3, as well as EsophaCap and EsoCheck have shown promising results in various studies when used with various biomarkers. Other modalities including circulatory microRNAs and volatile organic compounds that have demonstrated favorable outcomes. Use of these cell collection methods for BE surveillance is a potential area of future research.

Keywords: Barrett’s esophagus, Screening, Surveillance, Non-endoscopic, Cytosponge, Esophacap, Esocheck

Core Tip: This review summarizes the non-endoscopic modalities available for the screening and surveillance of Barrett’s esophagus which include esophageal imaging devices (trans-nasal endoscopy, esophageal capsule, tethered capsule endomicroscopy), cell collection devices (Cytosponge, Esophacap, Esocheck), circulatory micro-RNAs and volatile organic compounds. There is promise using some of the noninvasive modalities for mass screening in BE and a role in surveillance is yet to be determined.