Use of the EsoGuard® Molecular Biomarker Test in Non-Endoscopic Detection of Barrett's Esophagus among High-Risk Individuals in a Screening Population

Nicholas Shaheen, Mohamed Othman, Jawar Taunk, Kenneth J Chang, Sathya Jaganmohan, Patrick S Yachimski, John C Fang, Joseph S Spataro, Suman Verma, Victoria T Lee, Brian J deGuzman, Lishan Aklog
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Abstract

Background and Aims: Barrett's Esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC). We aimed to assess performance, safety, and tolerability of the EsoGuard (EG) assay on samples collected non-endoscopically with the EsoCheck (EC) device (EG/EC) for BE detection in the intended-use population, meeting American College of Gastroenterology (ACG) guideline criteria (chronic gastroesophageal reflux disease (GERD) and 3+ additional risk factors). Methods: We performed a prospective, multicenter study (NCT04293458) to assess EG performance (primary endpoint) on cells collected with EC, for detection of BE and EAC using esophagogastroduodenoscopy (EGD) and biopsies as the comparator. Twenty-four sites across the U.S. and Spain participated. EC safety and usability were assessed as secondary endpoints. Results: 180 male subjects aged >50 years with chronic GERD met eligibility criteria, of which 163 (90.6%) had EGD and successful EC administration. Mean age was 60.5yrs, 34.4% were obese, 56.7% had tobacco history, and 3.9% had a 1st degree relative with BE or EAC. Of 122 samples analyzed, 93 contributed to the primary endpoint analysis. About 9% of subjects in the Primary Analysis Population had BE on EGD, none with dysplasia. Sensitivity of EG for BE was 87.5% (95% CI 47.4-99.7), specificity was 81.2% (95% CI 71.2-88.8), positive predictive value was 30.4% (95% CI 13.2-52.9), and negative predictive value was 98.6% (95% CI 92.3-99.96). Mild esophageal abrasions were observed in 1.5%; no serious adverse events were reported. Conclusions: EG/EC appears effective for BE screening. This approach provides a safe, accurate, and well-tolerated non-endoscopic alternative in high-risk patients.
使用 EsoGuard® 分子生物标记物检验对筛查人群中的高危人群进行巴雷特食管的非内窥镜检测
背景与目的:巴雷特食管(Barrett's Esophagus,BE)是食管腺癌(EAC)的前兆。我们的目的是评估 EsoGuard (EG) 检测法的性能、安全性和耐受性,该检测法是在符合美国胃肠病学院 (ACG) 指南标准(慢性胃食管反流病 (GERD) 和 3 个以上其他风险因素)的预期使用人群中,使用 EsoCheck (EC) 设备(EG/EC)对非内镜采集的样本进行巴雷特食管检测:我们进行了一项前瞻性多中心研究(NCT04293458),以食管胃十二指肠镜检查(EGD)和活组织检查为参照物,评估EG对EC收集的细胞的性能(主要终点),以检测BE和EAC。美国和西班牙的 24 个研究机构参与了这项研究。EC的安全性和可用性作为次要终点进行评估:180名年龄在50岁左右、患有慢性胃食管反流病的男性受试者符合资格标准,其中163人(90.6%)接受了胃食管造影检查并成功实施了EC治疗。平均年龄为 60.5 岁,34.4% 肥胖,56.7% 有吸烟史,3.9% 的一级亲属患有 BE 或 EAC。在分析的 122 个样本中,93 个样本参与了主要终点分析。在主要分析人群中,约有 9% 的受试者在胃肠造影检查中发现了 BE,但没有发现发育不良。EG 对 BE 的敏感性为 87.5%(95% CI 47.4-99.7),特异性为 81.2%(95% CI 71.2-88.8),阳性预测值为 30.4%(95% CI 13.2-52.9),阴性预测值为 98.6%(95% CI 92.3-99.96)。1.5%的患者出现轻度食管擦伤;未报告严重不良事件。结论:EG/EC似乎对BE筛查有效。这种方法为高危患者提供了一种安全、准确、耐受性良好的非内窥镜替代方法。
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