Esophageal adenocarcinoma (EAC) and gastric cancer (GC) remain major causes of cancer-related mortality worldwide, largely because of late-stage diagnosis. Barrett’s esophagus (BE) is the established precursor setting for EAC, whereas gastric intestinal metaplasia is an important precursor lesion in the intestinal-type gastric carcinogenesis pathway. Aberrant DNA methylation arises early in both pathways and may offer greater sensitivity and specificity than histology or serology alone, while also illuminating the biology of neoplastic progression. This review evaluates the evidence and translational potential of DNA methylation biomarkers in upper gastrointestinal adenocarcinoma.

PubMed, Web of Science, and EMBASE were searched for studies published before May 2026 addressing DNA methylation biomarkers in BE, EAC, gastric intestinal metaplasia, and GC. Tissue-based, minimally invasive, and circulating biomarkers were reviewed, with emphasis on diagnostic performance, progression risk, biological significance, and clinical translation.

Methylation alterations accumulate during progression from precancerous lesions to invasive cancer and distinguish disease states in tissue and minimally invasive specimens. Methylation-based assays show promising diagnostic performance in BE and EAC, including nonendoscopic cytology-based approaches and risk-stratification assays, and circulating methylated DNA shows potential for noninvasive detection of EAC and GC. However, heterogeneity in populations, specimens, assay platforms, and study designs, together with limited prospective validation, remains a barrier to implementation.

The field is moving rapidly from discovery toward practice: Cytosponge-TFF3 with biomarker panels has been evaluated in real-world UK surveillance pathways, the EsoCheck/EsoGuard methylation assay is clinically available, and Esopredict is the first epigenetic prognostic assay clinically validated to risk-stratify BE, while multicancer early detection assays undergo prospective evaluation. Multicenter studies of clinical utility and cost-effectiveness remain the decisive step before routine adoption.

Endovascular embolization is a cornerstone treatment for intracranial aneurysms, and transfemoral access (TFA) has traditionally been the default vascular route. Transradial access (TRA) is increasingly used in neurointervention because it may reduce clinically important access-site complications, improve postprocedural comfort, and facilitate earlier ambulation. This narrative review aims to summarize direct and indirect evidence comparing TRA and TFA for intracranial aneurysm embolization, with attention to technical feasibility, access conversion, puncture-site complications, neurological events, radiation exposure, procedure duration, recovery, and cost considerations. Direct comparative evidence specific to aneurysm embolization remains limited and is mainly observational; some supporting data come from diagnostic cerebral angiography, mixed therapeutic neurointervention, and cardiovascular access literature. Available data suggest that TRA may be a safe and feasible option for selected patients when performed by experienced operators, particularly when radial anatomy is favorable and the intended device strategy is compatible with upper-extremity access. TFA remains essential for complex anatomy, large-bore device requirements, or insufficient TRA expertise. Access selection should therefore be individualized rather than based on a presumption of universal superiority. Well-designed multicenter studies are needed to define aneurysm-specific outcomes, long-term angiographic durability, patient-reported outcomes, and cost-effectiveness.