ACCURACY OF NON-ENDOSCOPIC SCREENING FOR BARRETT'S ESOPHAGUS (BE) AMONG PATIENTS ELIGIBLE FOR BE SCREENING

Background: Using EsoCheck (EC), a non-endoscopic balloon device for sampling the distal esophagus, coupled with EsoGuard (EG), a DNA based testing screening for Barrett’s esophagus (BE), we have previously reported high sensitivity and specificity for detection of BE among patients with known BE compared with controls. We now utilized this screening method in the population at risk for developing BE and esophageal adenocarcinoma (ECA).
Aim: Determine the accuracy of EG/EC in patients eligible for BE screening.
Method: We recruited veterans who meet American College of Gastroenterology (ACG) Guideline criteria for endoscopic BE screening at our VA hospital. Study participants completed EC/EG followed by esophagogastroduodenoscopy (EGD). We compared the yield of guideline based screening with a theoretical strategy where patients have EC/EG, and only those with a positive result then have an EGD.
Results: We enrolled 47 participants (89.3% male, median age 60.9 (SD 11.2)). 46/47 patients successfully swallowed the EC. In total, 10.6% (5/47) had an endoscopic diagnosis of BE. EC/EG was positive for 14 patients, negative for 23, and 9 patients did not have sufficient material for EG analysis. We found that 10.8% (4/37) patients had BE diagnosed by EGD, compared with 28.6% (4/14). There were no cases of BE diagnosed by endoscopy among patients with a negative EC/EG test. Compared with EGD the sensitivity and specificity of the test was 100% (95% CI 39.8% to 100%) and 69.7% (95% CI 51.3% to 84.4%), respectively. The PPV, NPV, and accuracy were 28.12% (95% CI 18.91% to 39.63%), 100.00%, 72.91% (95% CI 55.81% to 86.16%).
Conclusions: The performance of the EC/EG test was promising in the screening population and this study sets the ground for future larger trials of an EC/EG intervention for BE detection in the wider screening population.