Barrett’s Esophagus & TissueCypher® Testing
Surveillance Endoscopy · Biopsies · TissueCypher® Risk Testing
Barrett’s Esophagus Surveillance & TissueCypher® Risk Testing in Port Charlotte, FL
Barrett’s esophagus is a change in the lining of the lower esophagus, usually linked to long-standing acid reflux (GERD). Most people with Barrett’s never develop cancer, but because it is the known precursor to esophageal adenocarcinoma, regular surveillance endoscopy with biopsies is recommended. Dr. Matthew Tufts, MD, FACS performs these exams, and the TissueCypher® Barrett’s Esophagus Test (Castle Biosciences) may be recommended to help personalize your follow-up.
What is Barrett’s esophagus?
The esophagus is normally lined with flat, skin-like (squamous) cells. In Barrett’s esophagus, a stretch of that lining near the stomach is replaced by a different, intestine-like (columnar) lining, typically as a response to years of reflux. It usually causes no symptoms of its own; it is found during an upper endoscopy (EGD) and confirmed by biopsy.
Over time, a small number of people with Barrett’s develop dysplasia, precancerous changes graded as low-grade or high-grade, which can progress to esophageal adenocarcinoma. Finding dysplasia early allows it to be treated, often endoscopically, before cancer develops.
Why surveillance endoscopy with biopsies matters
Dysplasia often cannot be seen with the scope alone, so surveillance means a careful EGD with systematic biopsies taken around and along the Barrett’s segment following a standard sampling pattern (the “Seattle protocol”), plus targeted biopsies of any visible spots. A pathologist then grades the tissue. National guidance also recommends that people with Barrett’s take at least daily acid-reducing medicine (PPI) and that dysplasia be confirmed by an expert pathologist.
Typical surveillance schedule (ACG 2022 guideline)
The American College of Gastroenterology’s 2022 Barrett’s guideline bases the interval on the biopsy result and segment length:
| Biopsy finding | Suggested follow-up (ACG 2022) |
|---|---|
| No dysplasia, segment under 3 cm | EGD every 5 years |
| No dysplasia, segment 3 cm or longer | EGD every 3 years |
| Indefinite for dysplasia (confirmed by a second pathologist) | Repeat EGD within 6 months after increasing PPI to twice daily; then managed by the new result, or yearly EGD if still indefinite |
| Low-grade dysplasia (confirmed by a second pathologist) | Endoscopic eradication therapy is suggested; if surveillance is chosen instead, EGD at 6 and 12 months, then yearly |
| High-grade dysplasia | Generally treated with endoscopic eradication therapy |
Your own schedule may differ based on your history and findings; Dr. Tufts will tell you when your next exam is due.
If dysplasia is found, Dr. Tufts will discuss treatment options with you, which may include endoscopic eradication therapy (such as endoscopic resection or ablation) or referral when appropriate.
TissueCypher® Barrett’s Esophagus Test: personal risk from tissue already taken
Two people whose biopsies look the same under the microscope can carry different risks. The TissueCypher® Barrett’s Esophagus Test from Castle Biosciences is a laboratory test run on the biopsy tissue already collected during your endoscopy; no additional procedure is needed. Using an AI-driven imaging analysis of multiple protein biomarkers and tissue features, it estimates your individual 5-year risk of progressing to high-grade dysplasia or esophageal cancer.
- Who it is for: people with biopsy-confirmed Barrett’s that is non-dysplastic, indefinite for dysplasia or low-grade dysplasia
- How it works: if the test is recommended, Castle Biosciences arranges to receive your existing tissue from the pathology lab
- What you get: a risk score from 0 to 10, a risk class (low, intermediate or high) and an estimated 5-year probability of progression
- How it is used: a low-risk result may support standard or longer surveillance intervals for some patients, while a high-risk result may point toward closer surveillance or treatment
The American Gastroenterological Association’s 2022 clinical practice update states that a tissue systems pathology test (TissueCypher®) may be used for risk stratification of non-dysplastic Barrett’s esophagus. The ACG’s 2022 guideline did not make a recommendation on routine biomarker use because of limited data at that time. Published studies found the high-risk result to be highly specific but not very sensitive, so a low-risk result does not replace surveillance. Dr. Tufts will discuss whether the test may be recommended in your situation.
Barrett’s, reflux and surgery
Because Barrett’s grows out of chronic reflux, controlling reflux matters. Many patients do well on medication; others with ongoing symptoms or a hiatal hernia may consider anti-reflux or hiatal hernia surgery. If reflux has not been confirmed, MiVu™ mucosal integrity testing during your EGD may help.
Frequently asked questions about Barrett’s esophagus
Does Barrett’s esophagus mean I have cancer?
No. Barrett’s esophagus is a change in the lining of the esophagus, and most people with Barrett’s never develop esophageal cancer. Because it is the known precursor to esophageal adenocarcinoma, regular check-ups with endoscopy and biopsies are recommended to catch any precancerous change (dysplasia) early.
How often will I need an endoscopy?
It depends on your biopsy results and the length of the Barrett’s segment. For Barrett’s without dysplasia, the 2022 American College of Gastroenterology guideline suggests an EGD every 5 years for segments under 3 cm and every 3 years for segments 3 cm or longer. Dysplasia calls for closer follow-up or treatment. Dr. Tufts will give you a schedule based on your own results.
Does TissueCypher need another procedure?
No. TissueCypher is run by Castle Biosciences’ laboratory on biopsy tissue that was already taken during your endoscopy. If it is recommended, Castle Biosciences arranges to get the tissue from the pathology lab.
What does a TissueCypher result tell me?
The report gives a risk score from 0 to 10, a risk class (low, intermediate or high) and an estimated 5-year chance of progressing to high-grade dysplasia or esophageal cancer. Dr. Tufts uses it, along with your pathology and other risk factors, to help decide how closely to follow you or whether treatment should be considered.
Is TissueCypher covered by insurance?
Coverage varies by plan. Castle Biosciences says it works with Medicare, Medicaid, commercial insurers and the VA and has a patient assistance program, but some plans do not cover the test. Our office can help you check before it is ordered.
Sources
- ACG Guideline: Diagnosis and Management of Barrett’s Esophagus (Shaheen et al., 2022)
- AGA Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus (2022)
- Castle Biosciences: TissueCypher® overview
- Castle Biosciences: TissueCypher® order process & results
- Prediction of progression in Barrett’s esophagus using a tissue systems pathology test: pooled analysis of international multicenter studies
TissueCypher® is a registered trademark of Castle Biosciences, Inc. This page is general information, not medical advice.
Schedule a consultation with Dr. Tufts
Call Charlotte Harbor Surgical in Port Charlotte. Mon–Thu 7:30 am–4:00 pm, Fri 7:30 am–12:00 noon.