Castle-Biosciences

High anxiety and difficulty swallowing

Listen to how Dr. Loewe leveraged TissueCypher to upstage treatment for a highly anxious patient with a long history of GERD and recent trouble swallowing.

“[The patient] said to me: ‘Are you going to do anything with my Barrett’s at this time’…I said, ‘TissueCypher will give us that answer to lower your anxiety.’ ”

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Clinical risk factors

A 74-year-old male patient with a long history of GERD presented to Dr. Loewe with difficulty swallowing. Previous surveillance endoscopies from 3 years prior showed non-dysplastic Barrett’s esophagus.

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RELEVANT MEDICAL HISTORY

No family history of EAC
BMI 25
25 years of chronic GERD
Daily PPI: Rabeprazole 40 mg
Non-smoker

ADDITIONAL CONSIDERATIONS

Difficulty swallowing related to GERD
High anxiety level related to the potential development of EAC
Last EGD 3 years ago for surveillance of NDBE

Endoscopic findings

The endoscopy confirmed the presence of long-segment non-dysplastic Barrett’s esophagus by both traditional pathology and WATS^3D.

Lower esophagus:

BE segment: C4M5
2 cm hiatal hernia
Non-dysplastic pathology
WATS^3D-confirmed NDBE

Traditional Management:

Clinical profile: Low risk due to NDBE
Treatment recommendation: 3-5 yr surveillance

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TissueCypher results

TissueCypher results showed an intermediate-risk classification with a 5-year risk of progression of 7%, approaching the progression risk of confirmed low-grade dysplasia. Through shared decision-making, Dr. Loewe and the patient opted to remove the precancerous tissue using Endoscopic Eradication Therapy (EET).

Risk class: Intermediate
Risk score: 5.5
5-year risk of progression: 7%

TissueCypher-guided management

Change in management: upstaged due to shared decision making

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"Using shared decision making, [the patient] said to me 'I want you to get rid of that cancer risk'... and we proceeded with endoscopic eradication therapy."

Charles Loewe, MD

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Case details

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High anxiety and difficulty swallowing

Clinical risk factors

Endoscopic findings

Lower esophagus:

Traditional Management:

TissueCypher results

"Using shared decision making, [the patient] said to me 'I want you to get rid of that cancer risk'... and we proceeded with endoscopic eradication therapy."