Barrett's Oesophagus Surveillance, Real World Data for Usage of Capsule Sponge Sampling with Biomarker from a Teaching Hospital
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Yehia, A.
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2025
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Introduction: Barrett's oesophagus (BO) is a condition that develops as a consequence of chronic gastroesophageal reflux disease and a premalignant stage of adenocarcinoma of the oesophagus (EAC). In the US it is estimated that as many as 5.6 percent of adults have Barrett's esophagus.[ i] Estimates of the annual cancer incidence in patients with Barrett's esophagus have ranged from 0.1 to almost 3.0 percent. [ii] The goal of surveillance is to improve outcomes by detecting dysplasia or esophageal adenocarcinoma early enough to provide effective treatment. Guidelines suggest surveillance for most patients with Barrett's esophagus There are potential harms associated with surveillance, due to the risks associated with endoscopy, the risks and morbidity associated with invasive therapies used to treat lesions identified by surveillance.[iii] Patients with BO are currently recommended to enter a surveillance endoscopic program.[iv] This has been associated with a significant mental burden on these patients, presenting as various forms of anxiety and stress related to thoughts of disease progression as well as potential implications of the test, with many finding the program physically burdensome and intrusive. [v] Aims and Methods: In our study, from March 2024 until December 2024. patients with known BO were invited to undergo a tethered capsule procedure, instead of regular endoscopy, as part of their regular BO surveillance. Samples were sent for cytological analysis. Patients were identified as high risk if their cytology results came positive or equivocal for dysplasia or P53 chromosome over expression and then referred for gastroscopy for further biopsies and assessment. Result(s): We tested 144 patients. Mean age was 69 years old (youngest 32-oldest 90). Males were 62.5% and females 37.5%. 6.9% (N=10) came positive for dysplasia or atypia, while 2.8% (N=4) were inconclusive. P53 cytological analysis 2.1% were positive, while 4.2% were equivocal. Overall, our investigations identified 16 patients (11.1%) who were positive or equivocal for dysplasia and P53 mutation. In so far, we identified 1 patient with adenocarcinoma and 2 patients with biopsy proved dysplasia. Conclusion(s): Based on our results, sponge capsule combined with biomarker (P53) mutation could be offered for BO surveillance, as an alternative to regular endoscopy which could be burdensome. This could offer up opportunity for this non-invasive method, which could even be performed in the setting of regular outpatient clinic visits. This modality can potentially facilitate access to care for a larger population of patients and increase compliance similar to non-invasive tests for colorectal cancer screening programs.[iv] There were limitations our study. At this stage we could only review results for patients done at our hospital. And some patients with positive findings were still awaiting gastroscopy and biopsies. Further research on a larger cohort of patients is needed to analyze rate of diagnosis of dysplasia and adenocarcinoma, compared to OGD, which remains the gold standard.
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United.Eur.Gastroenterol.J.