Helena in’t Veld: Case 2

Helping a 56-year-old male take his risk seriously

   

Helena in’t Veld, FNP-C, helped a patient who was skeptical of his risk factors and pathology diagnosis. She leveraged a high-risk TissueCypher score to persuade him to act on his elevated risk of progressing from Barrett’s esophagus (BE) to cancer.

“Having that TissueCypher report, and having the percentage in front of the patient, makes it a lot more real to them. It upstaged our management, and he got endoscopic eradication therapy instead of just being monitored on medication a year later.”

 

Clinical risk factors

Helena consulted with a 56-year-old Hispanic male patient before a routine screening colonoscopy. She used these opportunities to also evaluate upper GI health. Given his age, chronic GERD, and obesity, he was a clear candidate to receive an upper endoscopy to screen for BE.

  • RELEVANT MEDICAL HISTORY
    • 10-year history of acid reflux
    • Self-medicated with over-the-counter options
    • Higher-than-average alcohol use
    • Non-smoker
    • BMI 35
  • ADDITIONAL CONSIDERATIONS
    • Already scheduled for routine screening colonoscopy
    • Textbook case of a patient that should be screened for BE 

Endoscopic findings

While reluctant, the patient proceeded with an upper endoscopy. During the procedure, the physician discovered a small hiatal hernia and short-segment BE that was later diagnosed as low-grade dysplasia (LGD).

Lower esophagus: 
  • Barrett's segment length: 1-2 cm
  • 3 cm hiatal hernia
  • Pathology diagnosis of LGD
Traditional Management: 
  • Clinical profile: High risk
  • Treatment recommendation: EET or 1-year surveillance

TissueCypher results

Helena ordered TissueCypher to help the skeptical patient make a decision on how to move forward. When the results returned as high risk, the patient agreed to move forward with ablation at an expert center.

  • Risk class: High
  • Risk score: 7.7
  • 5-year risk of progression: 24% 

TissueCypher-guided management

  • Proceed with referral for endoscopic eradication therapy

"Having that TissueCypher report, and having the percentage in front of the patient, it makes it a lot more real to them. It upstaged our management, and he got endoscopic eradication therapy instead of just being monitored on medication a year later.”

Helena in’t Veld, MSN, FNP-C

See other cases from Helena