Castle-Biosciences

Downstaging a patient referral for EET

This case features a 52-year-old male patient with a history of alcoholic cirrhosis complicated by portal hypertensive changes. The patient was referred by a colleague for consideration of EET.

“The straightforward decision to ablate or not ablate is not that straightforward. TissueCypher helped us to reassure a patient who is very anxious about this diagnosis.”

‍

Clinical risk factors

The 52-year-old male has experienced chronic GERD for many years and uses PPIs regularly. He is a former smoker with a history of alcoholic cirrhosis complicated by portal hypertensive gastropathy in the stomach.

‍

RELEVANT MEDICAL HISTORY

No relevant family history
Not obese
Chronic GERD for many years
PPI 40mg once daily
Former smoker

ADDITIONAL CONSIDERATIONS

History of GERD, well-controlled with PPI
History of alcoholic cirrhosis, complicated by portal hypertension
Patient significant anxiety regarding BE, referred for consideration of EET

Endoscopic findings

During endoscopy, Dr. Yepuri found a C2M5 segment of BE, but did not see any obvious esophageal varices. Judicious biopsies were taken, and pathology came back as non-dysplastic BE, suggesting a 3-year surveillance interval.

Lower esophagus:

BE segment– C2M5
No obvious esophageal varices
Biopsies returned non-dysplastic

Traditional Management:

Clinical profile: low-risk by histology
Treatment recommendation: 3-yr surveillance interval

‍

TissueCypher results

While this patient had been referred for consideration to EET, the decision to proceed required careful consideration. Given the patient’s underlying portal hypertension, EET carries elevated risks, which needed to be weighed against the patient’s individual risk of progression to high-grade dysplasia or cancer. The resulting TissueCypher results showed a low-risk TissueCypher classification and 3 percent risk of progression, which was very reassuring to Dr. Yepuri and his patient. The results allowed a confident recommendation to downstage to 3-year surveillance with TissueCypher testing at every other interval.

Risk class: Low
Risk score: 4.1
5-year risk of progression: 3%

TissueCypher-guided management

Downstaged
Patient elected to defer EET at this time and is comfortable with 3-year surveillance intervals

‍

“When you have a scenario with a patient with complex clinical factors, [TissueCypher] allows you to cut through all of those and be able to make an individualized treatment plan for this patient.”

Jay Yepuri, MD, FACG

‍

See other cases with Dr. Yepuri

Case details

View all cases

Case details

View all cases

Case details

View all cases

Downstaging a patient referral for EET

Clinical risk factors

Endoscopic findings

Lower esophagus:

Traditional Management:

TissueCypher results

“When you have a scenario with a patient with complex clinical factors, [TissueCypher] allows you to cut through all of those and be able to make an individualized treatment plan for this patient.”