Dr. Jay Yepuri: Case 1

Confirming low risk of progression in a young female patient

Listen to how Dr. Yepuri handled the case of a young female patient who received an unexpected diagnosis of Barrett's esophagus.

"We're going to be seeing more of these patients that don't quite fit that demographic profile of your typical patient with Barrett's — expect to see more people like this."

Clinical risk factors

19-year-old, female, white

A 19-year-old female patient presented to Dr. Yepuri with intermittent solid dysphasia and issues with nocturnal reflux. With no concern for family history of esophageal cancer, smoking, or PPI use, her clinical risk profile appeared to be low risk.

  • RELEVANT MEDICAL HISTORY
    • No relevant family history
    • Not obese
    • Nocturnal reflux
    • No PPI use
    • Non-smoker
  • ADDITIONAL CONSIDERATIONS
    • Presented for evaluation: 1-year of intermittent solid dysphasia
    • No current prescriptions

Endoscopic findings

Given her symptoms, Dr. Yepuri performed an upper endoscopy and found a C1M0 Prague classification of Barrett's esophagus (BE) with LA Grade A esophagitis but no hiatal hernia. Pathology came back as non-dysplastic BE. The BE diagnosis was surprising at such a young age, so appropriate risk stratification would be key to management.

Lower esophagus: 
  • BE segment: C1M0
  • No hiatal hernia
  • LA Grade A esophagitis
  • Biopsies returned non-dysplastic
Traditional Management: 
  • Clinical profile: low-risk by histology; however, BE at a young age was concerning
  • Treatment recommendation: 1-year surveillance

From top left to bottom left: Middle third of the esophagus, esophagistis, duodenal bulb

TissueCypher results

TissueCypher results revealed an individual low-risk classification, with a risk score of 4.1 and a 3% probability of progression. This helped to provide assurance that the appropriate care plan was guideline-based surveillance every 3 years, repeating TissueCypher testing every other interval. 

  • Risk class: Low
  • Risk score: 4.1
  • 5-year risk of progression: 3% 

TissueCypher-guided management

  • Change in management: Downstaged
  • While her young age was concerning, TissueCypher results helped to provide assurance that 3-year surveillance (per guidelines) is appropriate.

"We now have another tool [TissueCypher] that lets us more precisely manage these patients based on their individual profiles rather than a blanket approach to them." 

Jay Yepuri, MD, FACG

See other cases with Dr. Yepuri