What Is the Optimal Surveillance Strategy for Non-dysplastic Barrett’s Esophagus?

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Longer inspection time is associated with increased detection of high-grade dysplasia and esophageal adenocarcinoma in Barrett’s esophagus. Gastrointest Endosc. 2012;76:531–8. • Bergman JJGHM, de Groof AJ, Pech O, Ragunath K, Armstrong D, Mostafavi N, et al. An interactive web-based educational tool improves detection and delineation of Barrett’s esophagus–related neoplasia. Gastroenterology. 2019;156:1299–308 First web-based education tool to improve dysplasia detection. Cassani L, Sumner E, Slaughter JC, Yachimski P. Directional distribution of neoplasia in Barrett’s esophagus is not influenced by distance from the gastroesophageal junction. Gastrointest Endosc. 2013;77:877–82. Kariyawasam VC, Bourke MJ, Hourigan LF, Lim G, Moss A, Williams SJ, et al. Circumferential location predicts the risk of high-grade dysplasia and early adenocarcinoma in short-segment Barrett’s esophagus. Gastrointest Endosc. 2012;75:938–44. 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Gastrointest Endosc. 2018;87:348–55 A RCT demonstrated the improvement on dysplasia detection using WATS. • Smith MS, Ikonomi E, Bhuta R, Iorio N, Kataria RD, Kaul V, et al. Wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS) markedly improves detection of esophageal dysplasia and Barrett’s esophagus: analysis from a prospective multicenter community-based study. Dis Esophagus. 2019;32(3). https://doi.org/10.1093/dote/doy115 A large scale multi-center study showed WATS resulted in a substantial increase in dysplasia detection rate. Qumseya B, Sultan S, Bain P, Jamil L, Jacobson B, Anandasabapathy S, et al. ASGE guideline on screening and surveillance of Barrett’s esophagus. Gastrointest Endosc. 2019;90:335–59. Manfredi MA, Abu Dayyeh BK, Bhat YM, Chauhan SS, Gottlieb KT, Hwang JH, et al. Electronic chromoendoscopy. Gastrointest Endosc. 2015;81:249–61. Qumseya BJ, Wang H, Badie N, Uzomba RN, Parasa S, White DL, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett’s esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013;11:1562–70. Wolfsen HC, Crook JE, Krishna M, Achem SR, Devault KR, Bouras EP, et al. Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology. 2008;135:24–31. • Swager A-F, Tearney GJ, Leggett CL, van Oijen MGH, Meijer SL, Weusten BL, et al. Identification of volumetric laser endomicroscopy features predictive for early neoplasia in Barrett’s esophagus using high-quality histological correlation. Gastrointest Endosc. 2017;85:918–26 This study identified VLE features that are highly correlate with neoplasia and used these features to develop a scoring system for cancer prediction. Swager A-F, de Groof AJ, Meijer SL, Weusten BL, Curvers WL, Bergman JJ. Feasibility of laser marking in Barrett’s esophagus with volumetric laser endomicroscopy: first-in-man pilot study. Gastrointest Endosc. 2017;86:464–72. Wolfsen HC, Sharma P, Wallace MB, Leggett C, Tearney G, Wang KK. Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos). Gastrointest Endosc. 2015;82:631–40. • Smith MS, Cash B, Konda V, Trindade AJ, Gordon S, DeMeester S, et al. Volumetric laser endomicroscopy and its application to Barrett’s esophagus: results from a 1,000 patient registry. Dis Esophagus. 2019;32(9). https://doi.org/10.1093/dote/doz029 This study established the clinical feasibility and potential of VLE in improving dysplasia evaluation. van der Sommen F, Zinger S, Curvers W, Bisschops R, Pech O, Weusten B, et al. Computer-aided detection of early neoplastic lesions in Barrett’s esophagus. Endoscopy. 2016;48:617–24. • de Groof AJ, Struyvenberg MR, van der Putten J, van der Sommen F, Fockens KN, Curvers WL, et al. Deep-learning system detects neoplasia in patients with Barrett’s esophagus with higher accuracy than endoscopists in a multistep training and validation study with benchmarking. Gastroenterology. 2020;158:915–29 This study measured the performance of AI in detecting neoplasia and compared it with endoscopists. • Hashimoto R, Requa J, Tyler D, Ninh A, Tran E, Mai D, et al. Artificial intelligence using convolutional neural networks for real-time detection of early esophageal neoplasia in Barrett’s esophagus (with video). Gastrointest Endosc. 2020. https://doi.org/10.1016/j.gie.2019.12.049 The AI in this study showed excellent performance in accuracy, sensitivity, and specificity. Trindade AJ, McKinley MJ, Fan C, Leggett CL, Kahn A, Pleskow DK. Endoscopic surveillance of barrett’s esophagus using volumetric laser endomicroscopy with artificial intelligence image enhancement. Gastroenterology. 2019;157:303–5. Pohl H, Wrobel K, Bojarski C, Voderholzer W, Sonnenberg A, Rösch T, et al. 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