Original article
Clinical endoscopy
Volatile organic compounds in plasma for the diagnosis of esophageal adenocarcinoma: a pilot study

https://doi.org/10.1016/j.gie.2015.11.031Get rights and content

Background and Aims

A noninvasive screening test that can detect esophageal adenocarcinoma (EAC) at an earlier stage could improve the prognosis associated with EAC. The role of plasma volatile organic compounds (VOCs) for the diagnosis of EAC has not been previously studied.

Methods

Plasma samples were collected from subjects with EAC and GERD before endoscopy. Twenty-two preselected VOCs were analyzed with selected ion flow tube mass spectrometry.

Results

The headspaces from 39 plasma samples (20 EAC, 19 GERD) were analyzed. The levels of 9 VOCs (acetonitrile, acrylonitrile, carbon disulfide, isoprene, 1-heptene, 3-methylhexane, [E]-2-nonene, hydrogen sulfide, and triethylamine) were significantly altered in EAC patients compared with GERD patients. A multivariable logistic regression analysis was performed to build a model for the prediction of EAC. The model identified patients with EAC with an area under the curve of 0.83 (95% confidence interval, 0.67-0.98).

Conclusions

Plasma VOCs may be useful in diagnosing EAC. Larger studies are needed to confirm our pilot study observations.

Section snippets

Study population

A cross-sectional study was conducted by using samples from our endoscopy blood bank. After receiving approval from the Cleveland Clinic Institutional Review Board, we prospectively collected plasma samples from patients presenting for endoscopy between October 2012 and November 2013. The study population comprised 2 groups. The first group included patients with EAC presenting for an EUS staging examination. Our EAC group included patients with gastroesophageal junction tumors. Our second

Results

The headspaces from 39 plasma samples (20 with EAC, 19 with GERD) were analyzed. The demographic and clinical characteristics of the entire study cohort are shown in Table 1. As expected, patients with EAC were older (65.4 ± 10.7 vs 53.4 ± 16.5 years; P = .011), and had a lower body mass index (27.3 ± 4.8 vs 31.6 ± 8.4; P = .0054) than patients without EAC. There was a higher proportion of male patients (16 [80%] vs 5 [26.3%]; P = .01) in the EAC group. The disease characteristics of the study

Discussion

The main findings of our study are as follows: (1) Collecting and measuring plasma VOCs are feasible in an endoscopy population. (2) Certain plasma VOCs are differentially expressed in EAC patients compared with patients without EAC. (3) Measurement of VOCs in plasma is a promising noninvasive diagnostic tool to screen for EAC in patients with GERD.

The incidence of EAC is rapidly increasing in the Western world and has become the predominant type of esophageal cancer in the United States.1, 2, 3

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    DISCLOSURE: Supported in part by UL1TR000439, National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health and by an American College of Gastroenterology Clinical research grant award. All authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Bhatt at [email protected].

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