Jason Samarasena, MD, is a UCI Health physician who specializes in treating gastrointestinal disorders, including gastroesophageal reflux disease, esophageal disease, pancreatic cysts, biliary tract disorders, gastric intestinal metaplasia and colorectal cancer, talks about esophageal cancer and a new less-invasive and less time-consuming screening process method being implemented.
Interview conducted by Ivanhoe Broadcast News in November 2019.
What is esophageal cancer?
Dr. Samarasena: Esophageal cancer is a growth in the esophagus that arises from Barrett’s esophagus. Barrett’s esophagus is a pre-cancerous condition that comes directly from acid reflux. And acid reflux or gastroesophageal reflux disease, GERD, is a very, very common condition that afflicts a lot of Americans. About five to 15 percent of patients with GERD are at risk for pre-cancer and esophageal cancer.
And right now, how do you tell if GERD will progress to cancer?
Dr. Samarasena: Right now, the only way to screen somebody with reflux for Barrett’s esophagus and esophageal cancer is by doing something called an endoscopy or also known as an EGD, or Esophagogastroduodenoscopy. That’s where a flexible camera is put in through the mouth; almost always the patient is sedated for the procedure. The camera goes in through the mouth and down the esophagus into the stomach. And then we take high-definition pictures of the bottom of the esophagus to look for areas of Barrett’s esophagus; something called dysplasia, which is sort of the next step before cancer, or cancer itself.
It’s probably very time consuming. How long does a procedure like that take? Is it very costly?
Dr. Samarasena: Right. To get an endoscopy, basically, it would take about three to four hours of your day; typically from the time you come into a center that performs endoscopic procedures by a gastroenterologist. You’d have to be sedated for the procedure, and then the procedure itself takes about anywhere from 10 to 20 minutes. And then you’ll recover from sedation and then be discharged home. But on the day of the procedure, because you were given sedation, you can’t drive a car. And so it really does impact your life to come in for a screening test.
And what’s the cost of something like that?
Dr. Samarasena: It varies with different insurance companies, but it’s in the hundreds of dollars.
And now there’s a new way you’re testing?
Dr. Samarasena: Right. So for the first time now, we have a way to non-invasively screen for Barret’s esophagus and esophageal cancer. And this is a new device called Cytosponge. And like the name suggests, it’s actually a sponge and it’s encapsulated and tethered onto a string. Essentially what the patient would do is swallow the capsule and the capsule would move down the esophagus into the stomach. It would sit there for a few minutes. That capsule would dissolve, release the sponge, and then we would pull on the string. And as we’re pulling on the string, the sponge is touching the esophageal tissue and collecting cells. It collects about 500,000 cells throughout the esophagus, and then these cells can be analyzed by a pathology lab for any signs of Barrett’s esophagus, dysplasia or cancer.
Would you do this instead of an endoscopy? Or if you found cells would you then you go in with the camera or…?
Dr. Samarasena: Exactly. The way this is probably going to be used is somebody that decides not to do an endoscopy can opt to have this screening test. And a nurse or a medical assistant can administer this; it doesn’t require an MD to be present. If the cells on the sponge show that there is some pre-cancer, then that person would be directed to getting an endoscopy and evaluating further.
What would be the risk involved in this?
Dr. Samarasena: It’s a very low-risk procedure. It may be a little bit uncomfortable as the sponge is sort of being withdrawn, you know, from the esophagus and mouth. But that’s only just a few seconds and that’s probably the biggest risk with this procedure.
Do you think this is a game changer?
Dr. Samarasena: I really do think it is a big advance, and I really do think this is a game changer. Because one of the problems with this disease is it’s one of the fastest growing cancers in the United States. A lot of people live with reflux, live with Barret’s esophagus, live with esophageal cancer and they just don’t know it. And it isn’t until the cancer has grown large enough to obstruct food from coming down the esophagus that they’ll actually develop a symptom. By that time, it’s too late. Now, Barrett’s esophagus, early esophageal cancer, they’re actually very, very easy things for an endoscopist like myself to treat. We’ve got great technology to treat Barrett’s, Barrett’s with dysplasia, and even early esophageal cancer. But once that cancer invades through the wall or into the lymph nodes, the mortality rate is very high and the prognosis is poor. About 18 percent five-year survival compared to almost one hundred percent five-year survival if we’re treating just Barrett’s or Barrett’s with dysplasia or even early esophageal cancer.
And why is esophageal cancer one of the fastest growing?
Dr. Samarasena: That’s a great question. We’re not exactly sure why esophageal cancer is on the rise. We know that in the United States, obesity is on the rise. And with obesity, there’s a correlation between obesity and worsening reflux. So that may be one of the factors, but there’s probably things that we don’t understand that are at play as well.
So instead of taking a whole day of your life to get checked, this is going to turn into 20 minutes?
Dr. Samarasena: It could be a 20-minute part of your day to screen for something that could really affect your life in a bad way.
END OF INTERVIEW
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