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Diagnosis of Neoplasia in Barrett’s Esophagus using Vital-dye Enhanced Fluorescence Imaging
Published on: May 11, 2014
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NONENDOSCOPIC DETECTION OF BARRETT'S ESOPHAGUS IN PATIENTS WITHOUT GERD SYMPTOMS
Amitabh Chak1,2,3, Komal Keerthy1, Gi-Ming Wang2
1Division of Gastroenterology and Hepatology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106.
Medrxiv : the Preprint Server for Health Sciences
|April 8, 2025
Summary
This study shows non-endoscopic screening effectively detects Barrett's Esophagus (BE) in at-risk individuals without GERD symptoms. A negative test indicates a very low likelihood of BE, expanding screening opportunities.
Area of Science:
- Gastroenterology
- Oncology
- Molecular Diagnostics
Background:
- Barrett's Esophagus (BE) screening typically relies on upper endoscopy (EGD) for patients with GERD symptoms and risk factors.
- This approach misses individuals without GERD symptoms but with other risk factors, who constitute a significant portion of esophageal adenocarcinoma (EAC) cases.
- Current screening limitations highlight the need for non-invasive methods to detect BE in a broader at-risk population.
Purpose of the Study:
- To evaluate the efficacy of non-endoscopic methods for detecting BE in individuals at risk but without GERD symptoms.
- To assess the feasibility of using the EsoCheck device and EsoGuard methylation assay for BE screening.
- To determine the prevalence and predictive values of BE detection in this target population.
Main Methods:
- A prospective study recruited 132 patients undergoing colonoscopy with ≥3 BE risk factors and no GERD symptoms.
- The EsoCheck encapsulated balloon was administered, followed by analysis of samples using the EsoGuard BE detection methylated DNA marker panel.
- Patients with positive results underwent EGD; those with negative results were offered research EGD to calculate positive predictive value (PPV) and negative predictive value (NPV).
Main Results:
- The study included 132 participants (mean age 60.7 years, predominantly white males) with multiple BE risk factors.
- The EsoCheck and EsoGuard assay were successfully administered and analyzed in most participants.
- A PPV of 33% and NPV of 100% were observed for BE detection, with an estimated BE prevalence of 8.4% in this population.
Conclusions:
- Non-endoscopic screening using EsoCheck and EsoGuard can effectively identify BE in patients without GERD symptoms but with significant risk factors.
- This approach allows for the expansion of BE screening to a larger, currently underserved at-risk population.
- A negative non-endoscopic test result significantly lowers the probability of BE, supporting its utility in ruling out the condition.
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