Yepuri Case Study 3 | TissueCypher

Downstaging a patient referral for EET

This case features a 52-year-old male patient with a history of alcoholic cirrhosis complicated by portal hypertensive changes. The patient was referred by a colleague for consideration of EET.

“The straightforward decision to ablate or not ablate is not that straightforward. TissueCypher helped us to reassure a patient who is very anxious about this diagnosis.”

Clinical risk factors

52-year-old, male, white

The 52-year-old male has experienced chronic GERD for many years and uses PPIs regularly. He is a former smoker with a history of alcoholic cirrhosis complicated by portal hypertensive gastropathy in the stomach.

RELEVANT MEDICAL HISTORY
- No relevant family history
- Not obese
- Chronic GERD for many years
- PPI 40mg once daily
- Former smoker
ADDITIONAL CONSIDERATIONS
- History of GERD, well-controlled with PPI
- History of alcoholic cirrhosis, complicated by portal hypertension
- Patient significant anxiety regarding BE, referred for consideration of EET

Endoscopic findings

During endoscopy, Dr. Yepuri found a C2M5 segment of BE, but did not see any obvious esophageal varices. Judicious biopsies were taken, and pathology came back as non-dysplastic BE, suggesting a 3-year surveillance interval.

Lower esophagus:

BE segment– C2M5
No obvious esophageal varices
Biopsies returned non-dysplastic

Traditional Management:

Clinical profile: low-risk by histology
Treatment recommendation: 3-yr surveillance interval

From top left to bottom right - Lower third of the esophagus - Barrett’s esophagus, lower third of the esophagus - Barrett’s esophagus, lower third of the esophagus - Barrett’s esophagus, middle third of the esophagus

TissueCypher results

While this patient had been referred for consideration to EET, the decision to proceed required careful consideration. Given the patient’s underlying portal hypertension, EET carries elevated risks, which needed to be weighed against the patient’s individual risk of progression to high-grade dysplasia or cancer. The resulting TissueCypher results showed a low-risk TissueCypher classification and 3 percent risk of progression, which was very reassuring to Dr. Yepuri and his patient. The results allowed a confident recommendation to downstage to 3-year surveillance with TissueCypher testing at every other interval.

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

TissueCypher-guided management