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Dr. Daniel Tseng: Case 2
Helping an older patient be proactive in preventing EAC
An 81-year old male patient found himself on the fence about whether to continue ongoing surveillance of his BE. Up to this point he had no family history of EAC or even a diagnosis of dysplasia that would give him an objective reason to seek more aggressive management of his BE.
Read the case details below.
Clinical risk factors
81-year-old, male, Asian
The patient presented to Dr. Tseng with mixed clinical risk factors and high anxiety related to his non-dysplastic BE. He was not obese and had no relevant family history of esophageal cancer, suggesting a low risk of progression. However, he was experiencing chronic GERD and had a history of smoking, which are risk factors associated with higher risk.
Endoscopic findings
Dr. Tseng performed an upper endoscopy and collected biopsies, finding long-segment BE (Prague classification, C4M6), a 6 cm hiatal hernia, and a diagnosis of non-dysplastic Barrett’s esophagus. Traditional management based on these findings would be surveillance at a 3-year interval.
Lower esophagus:
- BE segment length: Prague C4M6
- Hiatal Hernia – Yes, 6 cm
- Pathology returned non-dysplastic (NDBE)
Traditional Management:
- Low risk clinical profile
- Treatment recommendation: 5 yr. surveillance
TissueCypher results
With the TissueCypher results in hand, Dr. Tseng shared with the patient his intermediate risk classification and 7% probability of progression over 5 years. Given this objective data, the patient agreed to move forward with radio-frequency ablation to remove his BE as well as anti-reflux surgery to mitigate its recurrence.
- Risk class: Intermediate
- Risk score: 6.2
- 5-year risk of progression: 10%
TissueCypher-guided management
- Change in management: Upstaged
"The feedback that I've gotten universally when I tell patients their [TissueCypher] score has been relief, knowing what exactly we're dealing with."
Daniel Tseng, MD, FACS