Surveillance in Barrett?s Esophagus: Challenges, Progress, and Possibilities

Endoscopic surveillance of Barrett's esophagus, aiming detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part the esophageal adenocarcinoma prevention paradigm. However, several limitations, such as the subtle appear-ance of dysplasia, sampling error (inherent in current surveillance protocols), and noncompliance with sur-veillance recommendations, lead to missed dysplasia and neoplasia, reducing the effectiveness of surveillance currently practiced. Careful endoscopic assessment with high-resolution white-light endoscopy, dye-based electronic chromoendoscopy, and comprehensive sam-pling of the BE mucosa, remains the cornerstone endoscopic surveillance. Emerging innovations in this area span the gamut of more efficient sampling methods, advanced imaging tools, artificial intelligence, and lecular marker-powered approaches as adjuncts, identify prevalent and predict incident dysplasia adenocarcinoma. Development and implementation validated quality indicators will allow additional advancement of this critical field. These approaches will hopefully enable efficient and effective cancer prevention and treatment.