Nonendoscopic Screening to Impact Esophageal Cancer in Veterans
Abstract
Objective and Rationale: Esophageal adenocarcinoma (EAC) has increased more than 6-fold in the past 4 decades. The Veteran population is at increased risk for EAC and its precursor lesion, Barrett’s esophagus (BE), due to increased prevalence of disease risk factors compared to the general population. BE is diagnosed only when patients undergo endoscopy with biopsies. However, due to the high cost of endoscopy and the lack of studies proving efficacy of screening, endoscopy to screen for BE is not routinely recommended. A simpler screening procedure similar to a pap smear would be an ideal way to sample the esophageal tissue for cancer and its precursor condition, BE. Our study proposes a nonendoscopic detection method administered in primary care offices, which would increase subsequent endoscopic detection of BE. Fiscal Year 2020 Peer Reviewed Cancer Research Program Topic Area: The proposed research falls within the Esophageal Cancer Topic Area. Specifically, this study seeks to answer whether a noninvasive test could help detect BE and EAC at an earlier stage and minimize the need for sedated upper endoscopy. Veterans are diagnosed with esophageal cancer at advanced stages of disease and have short disease survival periods, as most patient are not candidates for surgery to remove the tumor at the time of diagnosis. Impact of Research: This research will enroll 125 patients with chronic reflux symptoms who have not had a prior upper endoscopy. Each patient will have an unsedated EsoCheck test, which involves swallowing of a small retrievable capsule that can sample the lower part of esophagus. A research nurse will be trained to administer the EsoCheck device. Collected tissue samples will then be mailed to a molecular laboratory for analysis (EsoGuard assay). This lab test looks for DNA mutations common in the esophageal cancer. All patients will also undergo currently approved method of screening for BE and EAC; i.e., sedated upper endoscopy (esophagogastroduodenoscopy). We will use simple statistics to help determine how sensitive and specific is the noninvasive screening strategy. This research focuses on improving detection of BE in Veterans (and active-duty personnel) who are at risk for developing EAC. Proposed noninvasive unsedated detection method is less costly than sedated EGD. If our research shows that the addition of a noninvasive test via EsoCheck/EsoGuard to a screening algorithm improves detection of BE/EAC, then gastroenterologists will be more effective at diagnosing esophageal cancer early in our Veterans and potentially improve survival outcomes.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110586
Entities
People
- Katarina Greer
Organizations
- Louis Stokes Cleveland VA Medical Center
- United States Army