Simple test can determine which patients need endoscopy for Barrett’s oesophagusBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h527 (Published 02 February 2015) Cite this as: BMJ 2015;350:h527
A simple, minimally invasive test can be used to identify patients with reflux symptoms who may warrant endoscopy to diagnose Barrett’s oesophagus, research published in PLoS Medicine shows.
Barrett’s oesophagus is a commonly undiagnosed condition that predisposes patients to oesophageal adenocarcinoma. But routine endoscopic screening for Barrett’s oesophagus is not recommended because of the burden that it would impose on the healthcare system.
The case control study1 included 1110 people attending 11 UK hospitals for investigational endoscopy of dyspepsia and reflux symptoms. Before endoscopy they all swallowed a cell sampling device—a cytosponge—which was then tested using immunohistochemical staining for the biomarker Trefoil factor 3. Nearly 94% of the participants swallowed the cytosponge successfully and generally rated the experience as acceptable.
The test correctly identified 79.9% of the 647 patients in whom Barrett’s oesophagus was diagnosed by endoscopy. The sensitivity of the test increased to 87.2% in patients with circumferential Barrett’s segments of more than 3 cm in diameter, which are known to confer a higher cancer risk. The test also correctly identified 92.4% of the 463 people who were unaffected by Barrett’s oesophagus. And the sensitivity of the test increased to 89.7% in the 107 patients who swallowed the device twice during the study.
The authors, from the MRC Cancer Unit at the University of Cambridge, said that randomised controlled trials of the test are now needed to assess its suitability for clinical use. But they added that additional biomarkers would ideally need to be added to the test to identify those patients with the greatest risk of oesophageal cancer, to avoid overtreatment of Barrett’s oesophagus.
Cite this as: BMJ 2015;350:h527