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Clinical Summary: 2022 AGA Clinical Practice Update

AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus: Expert Review

V. Raman Muthusamy, MD, MAS, Sachin Wani, MD, C. Prakash Gyawali, MD, Srinadh Komanduri, MD, MS, for the CGIT Barrett’s Esophagus Consensus Conference, Clin Gastroenterol Hepatol 2022; https://doi.org/10.1016/j.cgh.2022.06.003

Dr. Raman Muthusamy speaks on the challenge of what he calls "The Barrett's Conundrum:" the situation in which there are effective treatment for high-risk Barrett's esophagus, but the challenge is identifying those patients with that condition.

Best Practice Statement #9

Tissue systems pathology-based prediction assay [TissueCypher] may be utilized for risk stratification of patients with non-dysplastic BE.

Background

The purpose of this best practice advice (BPA) article from the American Gastroenterological Association is to provide an update on advances and innovation regarding the screening and surveillance of Barrett’s esophagus.

The AGA Clinical Practice Update (CPU) recognizes TissueCypher’s ability to look beyond morphologic changes to identify high- and low-risk non-dysplastic Barrett’s esophagus (NDBE) patients. Best Practice Advice Statement #9 supports the clinical use of TissueCypher for risk stratification of patients with NDBE and cites validation data showing the progression rate of a patient with NDBE and a high-risk TissueCypher test result is 6.9%, similar to the progression rate in patients with low-grade dysplasia. The CPU proposes a new care pathway indicating that TissueCypher may be used for risk stratification of both newly diagnosed patients with Barrett’s esophagus and patients under surveillance.

Implications of using TissueCypher for patient management

  • Identifies high risk BE patients, including those that are NDBE, that are highly likely to progress to EAC, thereby enabling early intervention, high quality repeat endoscopy, or more frequent surveillance to prevent EAC
  • Identifies BE patients at very low risk of progression, thereby avoiding unnecessary procedures or surveillance endoscopies to be more efficient with limited healthcare resources

Cited Evidence

  • TissueCypher is validated to risk stratify BE patients for progression to HGD/EAC with 4.7-fold increased risk in
    high-risk vs low-risk patients
  • NDBE patients with a TissueCypher high-risk test result progressed at a rate similar to LGD (6.9%)
  • Markov modeling suggests that TissueCypher based risk stratification becomes cost-effective after 5 years
  • A pooled analysis by Mayo Clinic demonstrated that a TissueCypher high-risk score in NDBE patients was a strong independent predictor for progression to HGD/EAC (OR, 14.2; 95% CI, 5–39; P < .001)