Knowledge Check
Given the promising results of the EsoCheck and EsoGuard screening tools for Barrett’s esophagus and esophageal adenocarcinoma in a veteran population, what considerations would you take into account when evaluating the potential for widespread implementation of these noninvasive tests in clinical practice?
Noninvasive Screening Test for Barrett’s Esophagus Shows Promise
Prateek Sharma, MD, FASGE, reviewing Greer KB, et al. Am J Gastroenterol 2024 Jul 11.
A recent study tested noninvasive screening for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) using a combination of two devices approved by the U.S. Food and Drug Administration: EsoCheck (EC; Lucid Diagnostics, New York, NY), an esophageal sampling device, and EsoGuard (EG; Lucid Diagnostics), a DNA-based screening assay.
This single-center study prospectively evaluated participants who met guidelines for BE and EAC, were between the ages of 40 and 85, and had a history of symptomatic gastroesophageal reflux disease. The study enrolled 130 veterans (mean age, 62.6 years; the majority were White men), 124 of whom completed EGD and EC/EG screening.
The prevalence of BE/EAC detected on EGD was 12.9% (16/124; 95% confidence interval [CI], 7.6-20.1). For patients who completed EGD and EC/EG with adequate DNA samples, the sensitivity of EC/EG for BE and EAC was 92.9% (95% CI, 66.1-99.8) and the specificity was 72.2% (95% CI, 62.1-80.8). The mean postprocedure acceptability score for the EC test was 7.23 (standard deviation, 2.45), with 0 being the worst experience and 10 being the best experience.
COMMENT
This noninvasive test was well tolerated by a group of participants and showed promise as a screening tool.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Prateek Sharma, MD, FASGE
CITATION
Greer KB, Blum AE, Faulx AL, et al. Non-endoscopic screening for Barrett's esophagus and esophageal adenocarcinoma in at risk veterans. Am J Gastroenterol 2024 Jul 11. (Epub ahead of print) (https://doi.org/10.14309/ajg.0000000000002962)
COMMENT
This study affirms important principles for FIT screening. First, cancers detected by FIT remain in an early stage during subsequent screening rounds. Further, increasing the cutoff level of hemoglobin for positive test results reduces sensitivity but does not shift the fraction of detected cancers substantially toward later-stage CRC. Thus, programs can adjust the cutoff to levels appropriate for their colonoscopy resources, and the detected cancers will be in an early stage across a range of hemoglobin thresholds for positive tests.