Helena in’t Veld: Case 1

Anxious female patient with concerning family history

   

Helena in’t Veld, FNP-C, had a female patient with Barrett’s esophagus who her practice had followed for nearly 10 years. Despite always receiving a diagnosis of non-dysplastic Barrett’s esophagus (NDBE), the patient had a concerning family history and would routinely ask to shorten surveillance intervals.

“Every 18 months, sometimes 24 months, she would come back into the clinic and say ‘Can we do that EGD a little bit earlier? Do you really feel like 3 years is appropriate?”

See the case details below to learn how Helena helped this patient.

 

Clinical risk factors

A 73-year-old white female patient had been in Barrett’s esophagus surveillance for nearly 10 years. While her biopsies routinely came back NDBE, she was anxious because her father died of esophageal adenocarcinoma (EAC).

  • RELEVANT MEDICAL HISTORY
    • Chronic GERD; stable on PPIs
    • Significant family history:
      • Father died of EAC
      • Two brothers are diagnosed NDBE
    • Former smoker
  • ADDITIONAL CONSIDERATIONS
    • 10+ years with NDBE
    • Suggested surveillance interval is 3-years but the patient routinely called the office to request earlier EGDs

Endoscopic findings

Knowing that TissueCypher could be run retrospectively, Helena ordered the test on the patient’s most recent EGD from 1-2 years prior.

Lower esophagus: 
  • Barrett's segment length: 2 cm
  • 3 cm hiatal hernia
  • Pathology returned non-dysplastic
Traditional Management: 
  • Considered low-risk per guidelines, given her short segment and non-dysplastic histology
  • Treatment recommendation: 3-year surveillance

TissueCypher results

Helena and the patient were elated to learn that the TissueCypher results predicted a very low risk of progression. The patient was visibly overjoyed with the result, and agreed to maintain long-interval surveillance.

  • Risk class: Low
  • Risk score: 0.2
  • 5-year risk of progression: 0.3% 

TissueCypher-guided management

  • Maintain 3-year surveillance

“I gave her the results… and she practically broke down in tears at that point. She told me, ‘I have for years fretted about this because of my brothers’  histories and my father’s history lingering in the back of my mind.’ She just had this huge weight lifted off her shoulders [with these results]."

Helena in’t Veld, MSN, FNP-C

See other cases from Helena