Dr Sara Jamel (Oesophagus)

Dr Sara Jamel – Olympus/Guts UK Endoscopy Fellowship 2018

Institution: Imperial College London
Title: Profiling of Dysplastic Changes in Barrett’s Oesophagus and Early Oesophageal Cancer Using Non-Invasive Volatile Organic Compound Analysis of Exhaled Breath
Project Start Date:  1 April 2019
Completion Date: 31 March 2022

Summary:

Oesophageal cancer (cancer of the food pipe) is the fourth commonest cause of cancer death in the United Kingdom. Often this is because people don’t notice symptoms until the disease is at a late stage. Barrett’s oesophagus is a well-known condition that increases the risk of developing oesophageal cancer. In Barrett’s oesophagus, the cells lining the inside of the oesophagus change and can transform to early cancerous cells. This is called dysplasia. Between one to five out of a hundred people with Barrett’s oesophagus will go on to develop oesophageal cancer.

Currently, people with Barrett’s oesophagus have a routine endoscopy test where a small camera on a thin flexible tube looks at the lining of the oesophagus. Small samples of the lining (biopsies) can be taken to ensure that there are no signs of dysplasia or cancer. This means that any dysplasia or cancer can be found early allowing more patients to be treated at early stage.

The main research question is whether the cell changes in Barrett’s oesophagus can be detected by testing the breath of people with the condition. This will provide an easy and cheaper way to identify people at high risk of having dysplasia who should then have close monitoring to detect any signs of early cancer.

A clinical study will be carried out in four hospital sites with dedicated Barrett’s oesophagus services. Participants will be recruited when they attend the hospital for their routine endoscopy.  Before their endoscopy they will be asked to undergo a breath test.  The breath test is a quick method that is non-invasive and has no associated discomfort. It involves breathing out normally through a mask, to allow the breath to be collected into small tubes located within the mask. The breath samples will be analysed in a laboratory for gases omitted from cells, known as Volatile Organic Compounds (VOCs). The gases present in participants with and without dysplasia and cancer will be compared to identify the differences that could be used to test for the condition. We aim to recruit 463 participants across the 4 sites.

Endoscopy used for Barrett’s surveillance costs roughly £1500. The proportion of people with Barrett’s disease that will progress to early cancer is 0.9% to 1.0%.  This places a big financial burden on the National Health Service. Therefore, it is important to identify patients at risk, with the ultimate goal of targeting endoscopy towards the people at high risk of developing cancer. This study will look to introduce a new non-invasive and cost-effective test to monitor people with Barrett’s through means of breath testing. This will provide a more comfortable investigation for patients who are already anxious about the outcomes, enabling earlier diagnosis of those at risk and improving treatment success rates.

We are delighted to receive Guts UK's support to carry out this important work. Risk stratification of Barrett’s oesophagus is important. The funding from Guts UK/Olympus will allow us to create a non-invasive breath test for early detection of oesophageal cancer. We ultimately hope that this project and future research can help to identify patients with early oesophageal cancer and dysplasia and provide a risk stratification tool for this cohort. This will have significant cost saving to our healthcare system.

Dr Sara Jamel