Screening Patients for Barrett’s Esophagus with Cytosponge Coupled with Trefoil Factor 3 Expression Compared to Endoscopy

Background: Esophageal adenocarcinoma (EAC) accounts for an estimated 15 690 deaths in the US each year. The 5-year mortality is 80% unless the disease is caught early. Barrett’s esophagus (BE) is the primary risk for developing EAC, therefore, the best method for early detection is identification of patients with BE. In addition, recent advances in the treatment of high-grade dysplasia and early esophageal carcinoma have provided safe effective alternatives to esophagectomy. Endoscopy is the current standard to screen patients with BE. This method is cost prohibitive, invasive, and requires specialty training making it unfit as a tool for screening at risk populations. The Cytosponge coupled with trefoil factor 3 (TFF3) is a novel diagnostic test used in identifying Barrett’s esophagus. Is the Cytosponge coupled with TFF3 expression an effective method to diagnose patients with Barrett’s esophagus in comparison to endoscopy with biopsy? Methods: An exhaustive literature search using MEDLINE-Ovid, Web of Science, and Evidence Based Medical Review Multifile was conducted. The keywords used in the search included: “Barrett’s esophagus” and “Cytosponge.” Search results were subsequently scanned and eligibility criteria were applied. Studies were included if they directly compared the efficacy of Cytosponge coupled with TFF3 to endoscopy with biopsy. Other inclusion criteria required the studies to include human subjects and be in the English language. Studies were evaluated for quality using GRADE criteria. Results: A total of 13 studies were screened. After duplicates were removed and eligibility criteria were applied, two studies remained and are contained in this systematic review. One study included 504 participants and was a prospective cohort design. The second study was a multi-center case-control design and included 1110 participants. Both studies evaluated the sensitivity and specificity of the Cytopsonge-TFF3. One study demonstrated the sensitivity and specificity to be about 80% and 92% respectively. Conclusion: In conclusion, the Cytosponge-TFF3 possesses significant potential in its ability to be used as a cost effective, patient accepted, and accurate method for screening primary care populations for Barrett’s esophagus. Further clinical studies will be needed to determine the applicability and accuracy of the Cytosponge across primary care populations. Furthermore, additional steps need to be taken to improve the sensitivity of the Cytosponge, such as improvements related to bettering the reliability of specimen collection