Esophageal adenocarcinoma (EAC), the primary form of esophageal cancer in the United States, is a lethal cancer with exponentially increasing incidence. Screening for Barrett esophagus (BE), the only known precursor to EAC, followed by endoscopic surveillance to detect dysplasia and early-stage EAC and subsequent endoscopic treatment (to prevent progression of dysplasia to EAC and to treat early-stage EAC effectively) is recommended by several society guidelines. Sedated endoscopy (the primary current tool for BE screening) is both invasive and expensive, limiting its widespread use. In this review, we aim to provide a comprehensive review of recent innovations in the nonendoscopic detection of BE and EAC. These include swallowable cell sampling devices combined with protein and epigenetic biomarkers (which are now guideline endorsed as alternatives to sedated endoscopy), tethered capsule endomicroscopy, emerging peripheral blood–sampled molecular biomarkers, and exhaled volatile organic compounds. We also summarize progress and challenges in assessing BE and EAC risk, which is an important complementary component of the process for the clinical implementation of these innovative nonendoscopic tools, and propose a new paradigm for the strategy to reduce EAC incidence and mortality.

中文翻译：

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Barrett 食管和食管腺癌筛查的进展

食管腺癌（EAC）是美国食管癌的主要形式，是一种发病率呈指数级增长的致命癌症。建议对 Barrett 食管 (BE) 进行筛查，这是唯一已知的 EAC 前兆，然后进行内镜监测以检测不典型增生和早期 EAC，以及随后的内镜治疗（以防止不典型增生进展为 EAC 并有效治疗早期 EAC）遵循多项社会准则。镇静内窥镜检查（目前用于 BE 筛查的主要工具）既具有侵入性又昂贵，限制了其广泛使用。在这篇综述中，我们的目标是对 BE 和 EAC 非内镜检测的最新创新进行全面综述。这些包括与蛋白质和表观遗传生物标志物相结合的可吞咽细胞采样装置（现已被指南认可作为镇静内窥镜检查的替代品）、系留胶囊内窥镜检查、新兴的外周血采样分子生物标志物和呼出的挥发性有机化合物。我们还总结了评估 BE 和 EAC 风险方面的进展和挑战，这是这些创新的非内窥镜工具临床实施过程的重要补充组成部分，并提出了降低 EAC 发病率和死亡率的策略的新范例。