Targeted Diagnostics

A key strength of the All-Ireland Barrett’s registry platform (work package 1) is the ability to access linked tissue samples to generate a unique All-Island Integrated Analysis Platform to facilitate the in-depth study of the molecular biology of BO and OAC. AllCaN Oesophageal anticipates that this research platform will be unparalleled worldwide, providing the largest resource of BO samples and clinical data to enable biomarker discovery to predict progression of BO to OAC. While the majority of BO patients do not develop OAC, risk stratification measures to identify those at the highest risk of developing cancer are not available in clinical practice. Standard screening relies upon the identification of dysplasia to select patients for more intensive screening, ablation or even surgical resection. The detection of dysplasia shows substantial inter-observer variability between pathologists and requires a large population to undergo invasive and costly endoscopic surveillance. In short, current practice over-diagnoses low-risk non-progressive disease, while under-diagnosing high-risk life-threatening lesions. There is an immediate need to identify objective biomarkers to prioritise non-dysplastic Barrett’s oesophagus (NDBO) patients at greatest risk of progression to cancer. AllCaN Oesophageal hypothesises that an integrated analysis of gene expression and methylation data can be applied to develop biomarkers to predict which NDBO patients will progress to HGD/OAC. This will enable high-risk BO lesions to be eradicated endoscopically, while low-risk patients can have the frequency of endoscopic screening reduced or even discontinued. By building upon the pioneering work that has been undertaken within the Northern Ireland Barrett’s Register (NIBR), the Northern Ireland Biobank (NIB) and the Republic of Ireland Barrett’s Registry, Bioresource and Esophageal Cancer Network (RIBBON). AllCaN Oesophageal will assemble an unparalleled tissue and data resource for biomarker discovery and validation.