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Dr. John Lipham: Case 2
Long segment and TissueCypher low risk
A 38-year-old male with long-segment Barrett’s esophagus and a low-risk TissueCypher emphasized the need to consider all the factors of the case.
“So to me, all those [clinical factors] point to a little bit higher risk. But then we combine that with the TissueCypher results of lower risk, and I think, here, we meet in the middle.”
See the case details below.
Clinical risk factors
A 38-year-old male was scheduled for a surveillance endoscopy to check on his Barrett’s esophagus. He had previously suffered from chronic GERD, which was treated through PPIs and a laparoscopic Nissen procedure. He was mildly obese.
Endoscopic findings
During endoscopy, the Barrett’s esophagus segment length was measured at 4 cm, and the anti-reflux procedure was intact, but loosened. Pathology returned non-dysplastic.
Lower esophagus:
- Barrett's segment length: 4 cm
- Nissen with wrap intact
- GE flap Hill Grade II
- 1 cm paraesophageal hernia
- LA Grade A esophagitis in the distal esophagus
- Pathology returned non-dysplastic
Traditional Management:
- Clinical profile: Low risk
- Treatment recommendation: 3-year surveillance
TissueCypher results
Receiving a low-risk TissueCypher score, Dr. Lipham weighed those results against the clinical risk factors and felt comfortable keeping the existing 3-year surveillance interval.
- Risk class: Low
- Risk score: 3.9
- 5-year risk of progression: 3%
TissueCypher-guided management
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Continue 3-year surveillance
"So to me, all those [clinical factors] point to a little bit higher risk. But then we combine that with the TissueCypher results of lower risk, and I think, here, we meet in the middle."
John C. Lipham, MD