Enhancing the Diagnostic Yield of EGD for Diagnosis of Barrett Esophagus Through Methylated DNA Biomarker Triage.

Abstract

Background: EsoGuard (EG) is a methylated DNA assay for cells collected nonendoscopically with EsoCheck for detection of Barrett esophagus (BE) and can be utilized as a triage to esophagogastroduodenoscopy (EGD) in patients meeting clinical criteria for BE screening. EG triage may enrich the population undergoing EGD, increasing BE diagnosis without overburdening endoscopy resources.

Aim: To test the hypothesis that EGDs performed on patients who test positive on EG have higher diagnostic yields than screening EGDs alone.

Methods: We collected real-world retrospective data from EG-positive patients for whom EGD diagnoses were available. The diagnostic yield of these EGDs was measured by the BE detection rate. The yield of screening EGDs was estimated by literature-established disease prevalence (10.6%). The hypothesis was tested using t-test for single proportions at a one-sided 5% significance level.

Results: Among 209 patients, 60 (28.7%) had specialized intestinal metaplasia but 10 (4.8%) had less than 1 cm of nondysplastic disease. Because the American College of Gastroenterology (ACG) definition of BE requires disease length of at least 1 cm, these patients were excluded from analysis. In the analyzed population, we observed a 2.4-fold increase in BE detection compared with the 10.6% performance goal. There was a 2.7-fold increase in the cohort meeting ACG screening criteria and a 2.5-fold increase among those meeting ACG criteria who were aged 65 years and older.

Conclusion: EG triage enriches the population undergoing EGD for BE detection. Compared with screening EGD alone, it improves diagnostic yield. This may help direct more efficient use of endoscopy resources to improve disease detection in at-risk patients.