Modeling suggests a role for Cytosponge in post-RFA surveillance

This is one of the first examinations of the Cytosponge as a non-endoscopic method of surveillance in persons who have been treated for dysplasia in Barrett's. Results suggest that it may be more cost-effective than endoscopy.

Clin Gastroenterol Hepatol. 2021 Feb 10;S1542-3565(21)00147-6.
doi: 10.1016/j.cgh.2021.02.013. Online ahead of print.

Utility and Cost-Effectiveness of a Non-endoscopic Approach to Barrett's Esophagus Surveillance After Endoscopic Therapy

Swathi Eluri, Anna Paterson, Brianna N Lauren, Maria O'Donovan, Pradeep Bhandari, Massimiliano di Pietro, Minyi Lee, Rehan Haidry, Laurence Lovat, Krish Ragunath, Chin Hur, Rebecca C Fitzgerald, Nicholas J Shaheen

Abstract

Background & aims: A non-endoscopic approach to Barrett's esophagus (BE) surveillance after radiofrequency ablation (RFA) would offer a less invasive method for monitoring. We assessed the test characteristics and cost-effectiveness of the Cytosponge® in post-RFA patients.

Methods: We performed a multicenter study of dysplastic BE patients after at least one round of RFA. A positive Cytosponge® before endoscopy was defined as intestinal metaplasia (IM) on cytological assessment and/or TFF3 immunohistochemistry. Sensitivity, specificity, and receiver operator characteristic (ROC) curves were calculated. Multivariable regression was used to estimate the odds of a positive Cytosponge® in BE. A microsimulation cost-effectiveness model was performed to assess outcomes of various surveillance strategies: endoscopy-only, Cytosponge®-only, and alternating endoscopy/Cytosponge®.

Results: Of 234 patients, Cytosponge® adequately sampled the distal esophagus in 175 (75%). Of the 142 with both endoscopic and histologic data, 19 (13%) had residual/recurrent BE. For detecting any residual Barrett's, Cytosponge® had a sensitivity of 74%, specificity of 85%, accuracy of 84%, and ROC curve showed an area under the curve of 0.74. The adjusted odds of a positive Cytosponge® in BE were 17.1 (95% CI: 5.2-55.9). Cytosponge®-only surveillance dominated all the surveillance strategies, being both less costly and more effective. Cytosponge®-only surveillance required

Conclusions: A positive Cytosponge® test was strongly associated with residual BE after ablation. While the assay needs further refinement in this context, it could serve as a cost-effective surveillance examination.

Keywords: Barrett’s esophagus; Cytosponge; cost-effectiveness; dysplasia surveillance.

Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.

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