Determining personalized risk in a patient with low-grade dysplasia

Dr. Ronald Kotfila is a practicing gastroenterologist in Mississippi whose clinical work focuses on the diagnosis and management of gastrointestinal disorders, including reflux disease, inflammatory bowel conditions, and digestive health screening. He is the President of the Mississippi GI Society and has a strong interest in using prognostic and diagnostic tools that support accurate risk assessment and informed clinical decision-making in everyday GI practice.

In this case, Dr. Kotfila discusses a 75-year-old patient with Barrett’s esophagus who had two prior endoscopies that didn’t show signs of dysplasia, but his third endoscopy revealed low-grade dysplasia (LGD).

See the details below to learn how Dr. Kotfila navigated this case.

Older man with white hair and glasses reading or writing while seated on a couch at home.

Clinical risk factors

A 75-year-old, white male with chronic GERD and a previous long-term history of smoking is concerned about undergoing ablation to eradicate his Barrett’s.

RELEVANT MEDICAL HISTORY

BMI 26
Smoker, pack-per-day until late 40’s
Chronic GERD for 30 years, PPI daily

ADDITIONAL CONSIDERATIONS

The patient was concerned about RFA given his age.

Endoscopic findings

The endoscopy revealed the presence of low-grade dysplasia (LGD).

Lower esophagus:

BE segment length: C0M3
Pathology returned LGD
No hiatal hernia
‍

‍Traditional Management:

Guideline-based care: RFA or surveillance in 6-12 months

TissueCypher results

The patient was reassured upon receiving a TissueCypher low-risk score with a 5-year probability of progression of 0.8%. Because of the low risk of progression, Dr. Kotfila felt confident recommending surveillance instead of ablation.

Risk class: Low
Risk score: 2.0
5-year probability of progression: 0.8%

TissueCypher-guided management