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The following is a summary of “Novel devices and biomarkers in screening for esophageal squamous cell cancer,” published in the March 2025 issue of Best Practice & Research Clinical Gastroenterology by Januszewicz & Nowicki-Osuch.

Esophageal squamous cell carcinoma (ESCC) continues to pose a significant global health burden, largely due to its asymptomatic progression and consequent diagnosis at advanced stages, when curative treatment options are limited. Timely detection during the early stages, when the disease remains confined to the mucosa and can be effectively managed through endoscopic resection, is critical to improving patient survival and mitigating healthcare costs. However, the gold-standard diagnostic modality, conventional endoscopy, faces substantial challenges that limit its utility for widespread population-level screening. These challenges include its invasive nature, high operational costs, limited sensitivity in detecting early or precancerous lesions, and the requirement for trained personnel and specialized infrastructure. This review comprehensively examines current ESCC screening practices while exploring recent innovations in both endoscopic and non-endoscopic diagnostic methodologies. 

In the field of endoscopic imaging, researchers discuss the integration of artificial intelligence (AI)-driven platforms that improve lesion detection accuracy and reduce inter-operator variability, along with the application of confocal laser endomicroscopy for real-time, high-resolution cellular visualization. Furthermore, the study group assessed minimally invasive alternatives such as swallowable cytology-based devices, which have shown promise as cost-effective tools for early ESCC screening. These devices, when integrated with AI-powered cytological analysis and molecular biomarker evaluation, represent a viable alternative to conventional biopsies. The review also delves into the expanding field of liquid biopsy, offering an overview of circulating biomarkers such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), microRNAs, and serum proteins, all of which hold potential for early, non-invasive detection of ESCC. Additionally, emerging methods such as breathomics and salivary diagnostics are examined as potentially scalable and non-invasive screening tools with high patient compliance. Investigators also address the role of tissue biomarkers in stratifying patient risk and improving diagnostic precision, especially in identifying high-risk individuals during surveillance. 

Collectively, these novel approaches underscore a growing paradigm shift toward less invasive, more accessible, and highly sensitive screening strategies. As technological advancements continue to refine diagnostic capabilities, the integration of multi-modal screening approaches—including AI-enhanced imaging, liquid biopsy, and molecular diagnostics—may significantly enhance early ESCC detection and ultimately reduce disease-specific mortality. This review emphasizes the need for continued research and clinical validation to transition these innovations into standardized, real-world screening programs, particularly in high-incidence regions where resource constraints remain a barrier to effective screening implementation.

Source: sciencedirect.com/science/article/abs/pii/S1521691825000320