S877 Diagnostic Accuracy of Non-Endoscopic Cell Collection Devices for Barrett’s Esophagus: A Systematic Review and Meta-Analysis

Introduction: Barrett's esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EAC). Early detection and treatment of BE are crucial in preventing progression to EAC. Endoscopic screening is suggested, but uptake rates are low. Non-endoscopic screening tests combining swallowable esophageal cell collection devices with biomarkers such as TFF3 and methylated DNA markers (MDMs) have been guideline-endorsed as alternatives to endoscopy. We aimed to evaluate the diagnostic accuracy of these non-endoscopic screening tests in a systematic review and meta-analysis. Methods: We conducted a comprehensive literature search using PubMed, Embase, and Google Scholar to identify all the published studies analyzing the diagnostic accuracy of different non-endoscopic molecular BE screening tests, using the endoscopy as the comparator. We excluded studies using samples from prior trials or assessing post-ablation surveillance. Two reviewers independently screened titles, abstracts, and full texts. A random-effects meta-analysis was conducted to pool estimates of sensitivity and specificity, and heterogeneity was assessed using the I² statistic. Results: Out of 148 initial citations, 16 studies met inclusion criteria. These included 6 studies on Cytosponge (4 testing for TFF3, 1 combining TFF3 with p53, and 1 evaluating 7 biomarkers), 5 studies on EsoCheck (testing for methylation on the VIM and CCNA1 genes), and 5 studies on EsophaCap (4 testing for MDMs and 1 testing for Cytology and MUC2 IHC). The pooled sensitivity for the diagnosis of BE was 82.8% (95% confidence interval [CI] 78.3%-86.6%), and the pooled specificity was 86.7% (95% CI 78.0%-92.2%). Conclusion: Non-endoscopic cell collection devices demonstrate high diagnostic accuracy for BE and represent promising, minimally invasive alternatives to endoscopy. These tools could facilitate earlier detection and broaden access to screening in primary care and underserved settings.