Current technology not enough to prevent esophageal adenocarcinoma

SAN DIEGO — A “disruptive technology” is needed to make significant headway in preventing esophageal adenocarcinoma, a speaker said here.

“What we’re doing now, there’s a very good chance it’s not helping out patients much,” Nicholas J. Shaheen, MD, MPH, said while delivering the Emily Couric Memorial Lecture entitled “Can We Prevent Cancer in Barrett’s Esophagus?” during the American College of Gastroenterology Annual Scientific Meeting. “You could be looking for a disruptive technology to improve our approach to prevent this cancer.”

Until then, physicians should assume a series of small changes that will result in incremental improvements to the success rate in preventing this cancer, he said.

Chief among the incremental changes is obeying Sutton’s Law, which Shaheen explained involved performing screening tests on patients who are at greatest risk. In particular, physicians should pay attention to GERD complaints in older white males with truncal obesity.

But Shaheen also recommended gastroenterologists prepare themselves for a potential upcoming risk stratification panel that may provide insights based on anthropometric measurements, demographics, genetic markers and genotyping of key determinants of phenotypic expression.

“The biggest benefit here may be telling us who we don’t need to worry about: the 90% of patients with Barrett’s who are going to have nothing wrong go on with them that we can take out of our surveillance pool,” Shaheen said.

Another potential “disruptive technology” would be a low-cost, widely available screening test — potentially a nonendoscopic test — that would allow more individuals to more easily be screened.

Shaheen offered the example of a capsule on a string that would be swallowed by patients. The capsule would dissolve in the stomach and allow a sponge to emerge, that would then be pulled back, giving the equivalent of a Pap smear of the esophagus, he said.

“I think we do an awful lot of endoscopy that is low yield in our patients, does nothing but worry them, and probably benefits no one at great expense,” Shaheen concluded. “I look forward to the day we can change that and really make a dent in this disease.”

Disclosure: Shaheen is a consultant for Oncoscope and receives grant/research support from Covidien, CSA Medical, NeoGenomics, Shire and Takeda.