Episode 31, The one where I Interview Dr. Sachin Wani

I am excited to share insights from the Interventional Endoscopist podcast featuring Dr. Sachin Wani! The discussion centered on Barrett's esophagus, and strategies to improve detection and risk stratification

Key takeaways:
• The rising incidence of esophageal adenocarcinoma makes early detection crucial. Yet, survival rates remain low, highlighting the need for improved strategies

• PEEC and PEEN underscore the issue of missed lesions during endoscopy, emphasizing the need for high-quality exam.
• PEEC (postendoscopy esophageal adenocarcinoma) refers to cancer detected before the next recommended surveillance endoscopy in patients with non-dysplastic Barrett's esophagus. 
• PEEN (postendoscopy esophageal neoplasia) is a composite endpoint of high-grade dysplasia or cancer detected before the next recommended surveillance exam

• A high-quality endoscopic exam is paramount, including meticulous inspection, standardized classification, and advanced imaging techniques like chromoendoscopy. 
• A 10-step approach to a high-quality exam includes identifying landmarks, spending adequate time inspecting the Barrett's segment, cleaning the distal esophagus, and using high-definition white light endoscopy and virtual chromoendoscopy

• While the Seattle biopsy protocol is standard, it has limitations due to sampling errors
• WATS (Wide Area Transepithelial Sampling) can enhance neoplasia detection as an adjunct to the Seattle protocol by sampling the entire Barrett's segment.
• AI (artificial intelligence) holds promise for lesion detection, improved diagnostic accuracy, and quality assessment of endoscopic exams. AI platforms may help identify visible lesions and predict histology, as well as assess the quality of the endoscopic examination.
• The Tissue Cypher test can aid in risk stratification by analyzing biomarkers to predict the risk of progression to high-grade dysplasia. It can also predict prevalent high-grade dysplasia or cancer. 

• Dr. Wani also shared his journey into medicine, influenced by his family, and the challenges faced by foreign medical graduates. A key message was the importance of continuous improvement in endoscopic techniques and the integration of new technologies to combat esophageal adenocarcinoma

This episode was sponsored by Castle Biosciences the makers of the TIssue Cypher Test.