Clinical Utility of EsoGuard as a Triage Test for Endoscopy to Identify Barrett's Esophagus in Fire Fighters

BackgroundFirefighters have frequent exposure to compounds shown to increase risk of esophageal neoplasia. EsoGuard(R) (EG) is a DNA biomarker assay that can be utilized with efficiency and high tolerability as a triage to endoscopy for diagnosis of patients with Barretts Esophagus (BE), a known precursor to esophageal adenocarcinoma (EAC). This diagnostic tool may facilitate disease testing among busy at-risk firefighters. MethodsRetrospective analysis of prospectively collected clinical utility (CU) data for use of EG as a triage to more invasive endoscopic evaluation. EG was performed on esophageal cell samples collected with the nonendoscopic EsoCheck(R) (EC) device during two large cancer and pre-cancer screening events for firefighters in San Antonio, TX, in January 2023. CU was evaluated by provider impact assessment. Results388 firefighters were identified for EG testing, of which >99% (385/388) successfully completed EC cell collection. Over 96% (372/385) of tests had binary results; the remaining <4% failed analysis due to insufficient DNA. The EG positivity rate was 7.3% (28/385), all of whom were referred for specialist and upper endoscopy evaluation. Among those who tested negative, none were referred for further diagnostic workup. This represented a 100% concordance between EG results and physician management decisions. ConclusionsThis study capturing real-world data on use of EG in a population of firefighters demonstrates its ability to test many individuals rapidly and efficiently in a well-tolerated fashion, and reliable use of the test to triage individuals prior to pursuing more invasive and time-consuming diagnostic approaches.