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nasdaq
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Quote nasdaq Replybullet Topic: Surveillance Benefit?
    Posted: 21 Oct 2019 at 11:48am
Hi, I read several articles that our benefit form surveillance is only a small one. Can anybody explain me this?

I always thought that with our surveillance program we are the lucky ones?


https://www.gastrojournal.org/article/S0016-5085(18)30225-7/fulltext
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MarieDay
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Quote MarieDay Replybullet Posted: 23 Oct 2019 at 12:23pm
I just read the article too. It seems disheartening. I'm hoping I'm interpreting it wrong.
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nasdaq
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Quote nasdaq Replybullet Posted: 24 Oct 2019 at 8:38am
yes - but on the other side- hoping that i´m interpreting this correct - most of the studies where from a time where RFA/HALO treatment was not common. - only wait and watch strategy...... maybe chris can tell us more about this...
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chrisrob
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Quote chrisrob Replybullet Posted: 24 Oct 2019 at 9:55am
It is difficult to assess how beneficial surveillance scoping is.
Whereas over 90% of scopes show no change, when change is noted it can then be acted upon with RFA which is effective for LGD, HGD and OAC stage 1. How many progress to an inoperable stage between scheduled scopes is unclear. With improving surgical techniques, most diagnosed with stage 2 OAC may be successfully treated with oesophagectomy. It's those who aren't discovered until their cancer is a stage 4 who are most at risk with a prognosis typically measured in weeks.

I do remember discussing this with Prof Rebecca Fitzgerald a few years ago. Looked at purely in terms of time, cost and the percentage of cases discovered by routine surveillance, it can be questioned whether regular endoscopy is viable, however, for the reassurance provided to patients, it is invaluable.

As we discover better markers for those at highest risk, surveillance can be better targetted and with newer diagnostic tools becoming available (cytosponge, breath test, SPIT test etc), the need for scoping may be reduced.
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nasdaq
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Quote nasdaq Replybullet Posted: 24 Oct 2019 at 10:13am
thank you chris
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pylorius
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Quote pylorius Replybullet Posted: 24 Oct 2019 at 10:20am
Out of interest, are the newer diagnostic tests readily available or are they in the trialling stages?
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chrisrob
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Quote chrisrob Replybullet Posted: 24 Oct 2019 at 10:34am
Cytospongehas now completed its final round of clinical tests and, after 10 years in development, will hopefully start becoming widely available later next year.
Similar technologies of EsophaCap and EsoCheck being developed in US (where trials and testing isn't so protracted) may also be coming online at that time.
The Breat Test and Spit Test technologies have been proven and we know work but have entered the final 4 year phase of targeted clinical trials before they can become universally available.
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pylorius
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Quote pylorius Replybullet Posted: 24 Oct 2019 at 10:46am
Thanks Chris
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nasdaq
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Quote nasdaq Replybullet Posted: 24 Oct 2019 at 12:18pm
also interesting:

TissueCypher®
Link

Edited by nasdaq - 24 Oct 2019 at 12:19pm
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chrisrob
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Quote chrisrob Replybullet Posted: 24 Oct 2019 at 4:01pm
Looks interesting.
There is quite a surge of research attempting to identify markers.
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