Endoscopic screening of gastro-esophageal neoplasia: who, when and how?

Abstract

Background: Esophageal and gastric cancers continue to represent a significant global health challenge. Early detection through effective screening programs, along with primary prevention initiatives has the potential to substantially reduce mortality rates. Nevertheless, the widespread implementation of screening programs is impeded by both logistical and economic constraints. A thorough understanding of the epidemiology, pathogenesis, and risk factors is essential for developing more personalized and effective screening strategies. Summary: This narrative review provides an overview of the current status of endoscopic screening for gastroesophageal neoplasia, outlining the epidemiology, risk factors and primary and secondary prevention strategies. Although high-definition endoscopy, chromoendoscopy, and advanced imaging techniques have improved diagnostic accuracy, significant barriers remain in accessibility and cost-effectiveness. Consequently, the implementation of structured screening protocols and risk stratification is essential to optimize endoscopic utilization, ensuring the prioritization of high-risk populations and improving screening cost-efficiency. Concurrently, new technologies, such as artificial intelligence (AI) applications and non-endoscopic screening modalities, are being developed to improve and offer alternatives for the diagnosis of these malignancies. However, further research remains necessary to optimize these screening protocols and determine their clinical impact. Key Messages: Esophageal cancer (EC) and Gastric cancer (GC) remain a significant public health challenge due to their high mortality rates, associated with their late diagnosis. Endoscopic screening plays an essential role for early detection of esophageal and gastric cancer, improving survival outcomes. Despite technological progress, cost-effectiveness and accessibility remain major barriers to widespread implementation. Future strategies should focus on optimizing screening protocols, expanding training programs, and exploring cost-efficient approaches to ensure broader access to early detection methods.