Accuracy and Safety of the Cytosponge for Assessing Histologic Activity in Eosinophilic Esophagitis: A Two-Center Study

David A Katzka, Thomas Christopher Smyrk, Jeffrey A. Alexander, Debra M. Geno, Rose Mary A. Beitia, Audrey O. Chang, Nicholas J. Shaheen, Rebecca C. Fitzgerald, Evan S. Dellon

Research output: Contribution to journalArticle

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Abstract

Objectives:Management of eosinophilic esophagitis (EoE) requires repeated endoscopic mucosal sampling to assess disease activity. A less invasive and expensive means of monitoring of EoE is required. The objective of this study was to assess the accuracy, safety, and tolerability of the cytosponge compared to endoscopy and biopsy for histologic assessment of EoE.Methods:In this prospective two-center cross-sectional study, patients with known EoE underwent cytosponge sampling followed by endoscopy and biopsy. Sample adequacy and eosinophil counts (eos/HPF) were determined for both cytosponge and endoscopic samples. The cytosponge was assessed for diagnostic accuracy, safety, and patient preference as compared to endoscopy.Results:Six patients (7%) failed to swallow the sponge. One hundred and five procedures were successfully performed in 80 patients (66% male, 100% white, 19% stricture). The cytosponge sample was adequate in 102 and the biopsy in 104; 101 procedures had adequate samples by both techniques. Fifty-seven biopsies were graded as active EoE with ≥15 eos/HPF as the gold standard. Eosinophil counts highly correlated between the biopsy and cytosponge (r=0.78, P<0.0001). Using a cutoff of ≤15 eos/HPF for inactive disease, the sensitivity and specificity of the cytosponge was 75% and 86%, respectively. Six patients had active EoE on cytosponge not found on biopsy. For biopsies with inactive EoE, the cytosponge identified 38/44. No complications occurred, and cytosponge endoscopic abrasion scores were low (0.34/4). Patients preferred cytosponge to endoscopy with higher rating scores (7.27 vs. 6.11, P=0.002).Conclusions:Compared to endoscopy with biopsy, cytosponge provided a minimally invasive, safe, well tolerated, and accurate method to assess EoE histologic activity. (ClinicalTrial.gov number NCT01585103).

Original languageEnglish (US)
Pages (from-to)1538-1544
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume112
Issue number10
DOIs
StatePublished - Oct 1 2017

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Eosinophilic Esophagitis
Biopsy
Safety
Endoscopy
Eosinophils
Patient Preference
Porifera
Deglutition
Pathologic Constriction
Cross-Sectional Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Accuracy and Safety of the Cytosponge for Assessing Histologic Activity in Eosinophilic Esophagitis : A Two-Center Study. / Katzka, David A; Smyrk, Thomas Christopher; Alexander, Jeffrey A.; Geno, Debra M.; Beitia, Rose Mary A.; Chang, Audrey O.; Shaheen, Nicholas J.; Fitzgerald, Rebecca C.; Dellon, Evan S.

In: American Journal of Gastroenterology, Vol. 112, No. 10, 01.10.2017, p. 1538-1544.

Research output: Contribution to journalArticle

Katzka, DA, Smyrk, TC, Alexander, JA, Geno, DM, Beitia, RMA, Chang, AO, Shaheen, NJ, Fitzgerald, RC & Dellon, ES 2017, 'Accuracy and Safety of the Cytosponge for Assessing Histologic Activity in Eosinophilic Esophagitis: A Two-Center Study', American Journal of Gastroenterology, vol. 112, no. 10, pp. 1538-1544. https://doi.org/10.1038/ajg.2017.244
Katzka, David A ; Smyrk, Thomas Christopher ; Alexander, Jeffrey A. ; Geno, Debra M. ; Beitia, Rose Mary A. ; Chang, Audrey O. ; Shaheen, Nicholas J. ; Fitzgerald, Rebecca C. ; Dellon, Evan S. / Accuracy and Safety of the Cytosponge for Assessing Histologic Activity in Eosinophilic Esophagitis : A Two-Center Study. In: American Journal of Gastroenterology. 2017 ; Vol. 112, No. 10. pp. 1538-1544.
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abstract = "Objectives:Management of eosinophilic esophagitis (EoE) requires repeated endoscopic mucosal sampling to assess disease activity. A less invasive and expensive means of monitoring of EoE is required. The objective of this study was to assess the accuracy, safety, and tolerability of the cytosponge compared to endoscopy and biopsy for histologic assessment of EoE.Methods:In this prospective two-center cross-sectional study, patients with known EoE underwent cytosponge sampling followed by endoscopy and biopsy. Sample adequacy and eosinophil counts (eos/HPF) were determined for both cytosponge and endoscopic samples. The cytosponge was assessed for diagnostic accuracy, safety, and patient preference as compared to endoscopy.Results:Six patients (7{\%}) failed to swallow the sponge. One hundred and five procedures were successfully performed in 80 patients (66{\%} male, 100{\%} white, 19{\%} stricture). The cytosponge sample was adequate in 102 and the biopsy in 104; 101 procedures had adequate samples by both techniques. Fifty-seven biopsies were graded as active EoE with ≥15 eos/HPF as the gold standard. Eosinophil counts highly correlated between the biopsy and cytosponge (r=0.78, P<0.0001). Using a cutoff of ≤15 eos/HPF for inactive disease, the sensitivity and specificity of the cytosponge was 75{\%} and 86{\%}, respectively. Six patients had active EoE on cytosponge not found on biopsy. For biopsies with inactive EoE, the cytosponge identified 38/44. No complications occurred, and cytosponge endoscopic abrasion scores were low (0.34/4). Patients preferred cytosponge to endoscopy with higher rating scores (7.27 vs. 6.11, P=0.002).Conclusions:Compared to endoscopy with biopsy, cytosponge provided a minimally invasive, safe, well tolerated, and accurate method to assess EoE histologic activity. (ClinicalTrial.gov number NCT01585103).",
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AU - Smyrk, Thomas Christopher

AU - Alexander, Jeffrey A.

AU - Geno, Debra M.

AU - Beitia, Rose Mary A.

AU - Chang, Audrey O.

AU - Shaheen, Nicholas J.

AU - Fitzgerald, Rebecca C.

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