Residual Barrett esophagus after ablation was found to be accurately detected with a positive CytospongeÒ test. These findings, from a prospective multicenter study, were published in Clinical Gastroenterology and Hepatology.
Patients (N=234) with dysplastic Barrett esophagus scheduled for further ablative therapy after one round of endoscopic eradication therapy (EET) were recruited at 4 centers in the United Kingdom and 1 in the United States. Two hours prior to endoscopy, the CytospongeÒ test was performed, which consisted of the ingestion of the CytospongeÒ capsule with approximately 50 mL of water and removal after 7 minutes via an attached string. The sponge was then assessed for the presence of goblet cells.
Only a subset of patients (n=175) had viable CytospongeÒ samples among patients aged mean 71±9 years; 83% were men, and prior ablation occurred a median of 20 months previously. During endoscopy, 65% of these patients had no columnar epithelium, 25% had short segments of columnar epithelium, and 10% had long segments of columnar epithelium. Patients with inadequate CytospongeÒ samples had either no Barrett esophagus (92%) or short-segment Barrett esophagus.
Among patients with adequate CytospongeÒ samples and histologic data (n=142), 87% were defined as non-Barrett esophagus controls. The CytospongeÒ test was positive among 74% of patients with Barrett esophagus and 15% of non- Barrett esophagus controls (P <.01) and negative for 85% of non-Barrett esophagus controls and 26% of patients with Barrett esophagus.
These values indicate the CytospongeÒ assay to have had a sensitivity of 74% (95% CI, 49-91), a specificity of 85% (95% CI, 78-91), accuracy of 84% (95% CI, 77-89), and area under the receiving operator characteristic curve (AUC) of 0.74.
False-negative cases of Barrett esophagus occurred among patients with long-segment Barrett esophagus (n=4; mean segment length, 7.8 cm; range, 4-11) and short-segment Barrett esophagus (n=1). The non-Barrett esophagus controls for whom a false-positive result was reported had less than 1 cm endoscopic columnar epithelium (n=5), normal esophagus with intestinal metaplasia of the cardia (n=3), or an unknown etiology causing the false positive result (n=10).
The cost of quality-adjusted life-years (QALY) per 1000 patients of no endoscopic surveillance among those with Barrett esophagus was calculated at $8,792,073 (QALY, 11,734); the cost for endoscopy was $12,364,203 (QALY, 11,839), and the cost for CytospongeÒ was $10,245,325 (QALY, 11,844). These values reveal CytospongeÒ to be a more cost-beneficial approach compared with no surveillance (incremental cost-effectiveness ratio [ICER], $13,259 per QALY).
This study was likely limited by the proportion of inadequate CytospongeÒ tests, which was higher than reported in a previous study. In addition, the estimation of cost-effectiveness may not be reflective of real-world adherence to the surveillance program.
These data suggest that the CytospongeÒ may be effective in detecting residual Barrett esophagus among patients who had undergone eradication procedures and has the potential to be more cost-effective than no surveillance strategy.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Eluri S, Paterson A, Lauren BN, et al. Utility and cost-effectiveness of a non-endoscopic approach to Barrett’s esophagus surveillance after endoscopic therapy. Clin Gastroenterol Hepatol. Published online February 10, 2021. doi:10.1016/j.cgh.2021.02.013