Barrett High-Grade Dysplasia and Early Esophageal Adenocarcinoma in Patients With Positive Results on a Nonendoscopic Methylated DNA Biomarker Test

Barrett esophagus (BE) is the precursor for esophageal adenocarcinoma (EAC), with an at-risk screening population clearly defined by gastroenterology society guidelines. BE with high-grade dysplasia (HGD) and early EAC are actionable diagnoses, where endoscopic eradication therapy (EET) is effective in avoiding progression to invasive EAC. EsoGuard (EG) is a methylated DNA biomarker assay performed on esophageal cells collected nonendoscopically with EsoCheck (EC) to facilitate in-office BE screening. This case series presents 4 cases of HGD/early EAC diagnosed in patients who first tested positive on EG. Case presentations: Two patients met American College of Gastroenterology guideline criteria for BE screening, and 2 lacked chronic gastroesophageal reflux disease (GERD) but met other risk criteria. The patients with chronic GERD had well-controlled symptoms on proton pump inhibitors, and none of the patients had ever previously undergone screening for BE with esophagogastroduodenoscopy (EGD). All 4 patients underwent confirmatory EGD after receiving positive EG results, with HGD diagnosed on biopsy specimens. All patients were subsequently referred to advanced endoscopists for EET, during which time a T1a lesion was identified in 1 patient’s endoscopic mucosal resection specimen. All achieved complete disease eradication after EET. Conclusion: These cases demonstrate EG/EC as an in-office nonendoscopic triage test that facilitated the timely diagnosis and subsequent treatment of HGD/early EAC in 4 patients who would otherwise not have undergone screening EGD and would have been at risk for progression to EAC. EG/EC allows BE screening in nonspecialized facilities and may be a reasonable option for patients who have not already been referred for endoscopy.