Can a Swallowable Capsule Revolutionize Screening for Esophageal Cancer

 UH Clinical Update - October 2018

Although the rate of many common cancers has declined, the incidence of esophageal adenocarcinoma has increased greater than six-fold over the past three decades. Furthermore, the outcome of this cancer remains poor, accounting for over one in 50 adult male cancer-related deaths.

Barrett’s esophagus (BE), a precursor of esophageal cancer, can be easily recognized at endoscopy; however, current clinical strategies of endoscopic screening and surveillance based on the close association of BE with chronic gastroesophageal reflux disease (GERD) in adults are woefully inadequate. Despite endoscopic screening and surveillance efforts, less than 5 percent of esophageal cancers are diagnosed in individuals with previously detected BE.

UH gastroenterologist Amitabh Chak, MD, is looking to change this state of affairs. He’s leading a NIH-funded, multi-center clinical trial aimed at improving outcomes for patients with BE and esophageal cancer.

“In recognition of the burden of morbidity and mortality caused by esophageal cancer and the clinical need to develop more effective screening, surveillance, and ablative strategies for BE, we’re aiming to develop new molecular approaches for improving the detection, prognostication and treatment of BE, with the ultimate goal of reducing the mortality associated with this cancer,” he says.

Specifically, Dr. Chak and his study collaborators are testing whether a swallowable capsule can gather genetic information about important biomarkers in BE and esophageal cancer – crucially, which biomarkers seem to signal increased likelihood of disease progression.

“In a pilot study of 138 subjects, this capsule esophageal sampling was performed with no adverse events reported,” he says. “Similar esophageal sampling devices have been reported on over 1600 patients with no adverse events.”

The study under way involves four groups of patients:

1. Adults 18 and older with known BE or esophageal cancer
2. Adults between age 40 and 85 who’ve had heartburn for at least five years and are having esophago-gastro-duodenoscopy (EGD) for evaluation of GERD
3. Adults between age 40 and 85 who’ve had heartburn or taken proton pump inhibitors for at least five years and are referred for a screening colonoscopy
4. Adult controls 18 and older who are having an EGD without signs of BE or esophageal cancer

White males are at increased risk of BE and esophageal cancer, which is reflected in the study’s inclusion criteria. In groups 2 and 3, the subject must be a white male OR have at least three of the following criteria:

• Male gender
• White race
• Obesity (BMI > 30)
• History of smoking
• Family history – two family members with reported BE or esophageal cancer

If you have a patient who could benefit from this clinical trial, please email Study Coordinator Wendy.Brock@UHhospitals.org.