Novel Low-Cost Minimally Invasive Esophageal Screening Tool and Its Implementation in a Multidisciplinary Otolaryngology and Speech-Language Pathology Clinic

Purpose: Esophageal adenocarcinoma (EAC) is a malignant tumor that develops in the glandular epithelium in the lower portion of the esophagus. EAC and its precursor, Barrett's esophagus (BE), have multiple risk factors including gastroesophageal reflux disease, male sex, White race, obesity, smoking, and family history. Among those who meet the screening criteria, only 10% undergo upper endoscopy, which is the current standard of care. EsoGuard, an office-based tool used to sample the esophagus, offers a quick and low-cost screening method. Our study was designed to use EsoGuard and promote patient awareness through a multidisciplinary otolaryngology and speech-language pathology clinic to improve screening adherence. Method: A flyer was sent to all employees at a tertiary care center to describe the risk factors for BE. Screening was performed using EsoGuard within a multidisciplinary otolaryngology and speech-language pathology clinic. Questionnaires regarding risk factors, the Reflux Symptom Index (RSI), and the Eating Assessment Tool (EAT-10) were obtained. Results: A total of 97.8% of these patients completed the screening. Of the participants, 86.9% were White, 26% were male, one was a smoker, 56.5% had heartburn, 21.7% had a family history, and 41.3% had obesity. Ten participants reported dysphagia. The mean EAT-10 score was 1.10. One third of the patients had an RSI score of ≥ 14. Positive results were observed in 24.4% of patients, negative results were observed in 71%, and inconclusive results were observed in 4.4%. Among those with positive results, 63.6% completed the recommended endoscopy. Of these, 71.4% showed abnormal findings. Conclusions: The incidence of EACs is increasing, and only 10% of eligible patients are screened. EsoGuard has the potential to increase the number of screenings because it is less costly and less invasive. Education encourages patients to be screened and provides beneficial discussions with physicians. Otolaryngology and speech-language pathology providers should be aware of the risk factors for BE and encourage those who meet the criteria to be screened, as many of their patients present with qualifying risk factors. Supplemental Material: https://doi.org/10.23641/asha.34892550