How far to go? Screening and surveillance in Barrett's esophagus

There is no dispute that Barrett's esophagus (BE) is associated with an inc reased risk of esophageal adenocarcinoma. Detecting these cancers early can improve patient survival. But should screening be used to detect BE, or sh ould a surveillance program monitor those already diagnosed with BE for neo plastic changes? Endoscopy and endoscopic biopsy are the only tools availab le for such screening and surveillance, and the cost effectiveness of eithe r approach must be considered. Two possible solutions are discussed. First, screening could be limited to patients considered at high risk for BE and associated adenocarcinoma. With this approach, more precise risk stratifica tion would be required. The second possible approach is to combine screenin g for high-risk patients and surveillance for those already diagnosed with BE. Additional outcomes data are needed to determine how Often and for what length of time endoscopic surveillance should continue in a patient after several examinations are negative for adenocarcinoma.