Inclusion Criteria:

• Adult patients 18-85 years old.

• Intervention clusters: BE Risk Tool Score > 0.087, indicating a higher risk for BE/EAC. This will be run as a web-based application integrating data from several domains in the electronic health record (EPIC).. Output score will range from 0-1.

• Control clusters: Meeting ACG screening criteria (GERD+ > 2 BE risk factors:: Age ≥ 50 years, Male sex, Caucasian race, obesity (BMI > 30), ever smoker, family history of BE/EAC)

Exclusion Criteria:

• History of Barrett's esophagus or esophageal adenocarcinoma.
• Prior endoscopy in the last 10 years.
• Patients who are unable to consent.
• Patients with a current history of uninvestigated dysphagia.
• History of eosinophilic esophagitis, achalasia.
• Patients on oral anticoagulation including Coumadin, Warfarin unless discontinued for five days prior to the sponge procedure.
• Patients on antiplatelet agents including Clopidogrel, unless discontinued for five days prior to the sponge procedure.
• Patients on oral thrombin inhibitors including Dabigatran and oral factor X a inhibitors such as rivaroxaban, apixaban, and edoxaban, unless discontinued for five days prior to the sponge procedure.
• Patients with a history of known varices or cirrhosis.
• Patients with a history of esophageal or gastric resection for esophageal or gastric carcinoma.
• Patients with congenital or acquired bleeding diatheses.
• Patients with a history of esophageal squamous dysplasia or esophageal squamous carcinoma.
• Patients with limited life expectancy (< 2 years): per provider judgement.

Specific Aim 1b:

Inclusion Criteria:

• a “low risk” BE risk tool score (< 0.0897)

Exclusion criteria:

• History of Barrett's esophagus or esophageal adenocarcinoma.

• Prior endoscopy in the last 10 years.

• Patients who are unable to consent.

• Patients with a current history of uninvestigated dysphagia.

• History of eosinophilic esophagitis, achalasia.

• Patients on oral anticoagulation including Coumadin, Warfarin unless discontinued for five days prior to procedure.

• Patients on antiplatelet agents including Clopidogrel, unless discontinued for five days prior to procedure.

• Patients on oral thrombin inhibitors including Dabigatran and oral factor X a inhibitors such as rivaroxaban, apixaban, and edoxaban, unless discontinued for five days prior to procedure.

Note: Other protocol defined Inclusion/Exclusion Criteria may apply.

Eligibility last updated 3/24/2025. Questions regarding updates should be directed to the study team contact.