Utility of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis as an adjunct to forceps biopsy sampling in the surveillance of patients with Barrett’s esophagus after endoscopic eradication therapy

TL;DR

This study shows that using wide-area transepithelial sampling with 3D analysis improves detection of Barrett’s esophagus recurrence after treatment, especially when no visible signs are present.

Contribution

The study demonstrates the added diagnostic value of WATS-3D as an adjunct to standard biopsy in post-EET BE surveillance.

Findings

WATS-3D increased the detection of intestinal metaplasia by 52.5% and dysplasia by 91.5% when used with standard biopsies.

In patients with no visible BE, WATS-3D detected IM with an adjunctive yield of 260%.

Eleven cases of high-grade dysplasia or cancer were missed by forceps biopsy but detected by WATS-3D.

Abstract

Recurrence of Barrett’s esophagus (BE) and associated dysplasia is not uncommon after endoscopic eradication therapy (EET). However, the most optimal method for detection of residual/recurrent disease remains unknown. This study evaluated the utility of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS-3D) as an adjunct to standard forceps biopsy (FB) sampling for detection of BE and dysplasia after EET.

Data were examined from 2 large commercial registries of community practices that prospectively evaluated BE surveillance using both standard FB sampling combined with WATS-3D. Comprising the study cohort were 1114 consecutive BE patients (mean age, 68.9; men 68.1%, women 31.9%) who had EET. The adjunctive (and absolute) increased yield of WATS-3D for detection of intestinal metaplasia (IM) and dysplasia was evaluated according to the extent of endoscopic residual BE.

The WATS-3D adjunctive yield for detection of residual/recurrent IM or dysplasia was 52.5% and 91.5%, respectively. The highest adjunctive yield for detection of IM (260%) occurred in patients without any gross endoscopic evidence of residual or recurrent BE. The absolute yield for IM and dysplasia detection was 16% and 4.4%, respectively, and dysplasia detection was significantly greater in patients with visible BE compared with those with no endoscopic evidence of residual BE. Of 29 patients with high-grade dysplasia or esophageal adenocarcinoma detected by WATS-3D, FB sampling missed 11, including 7 where FB sampling did not detect any IM. The number of patients needed to test for detection of residual/recurrent BE was 6.2 and for detection of dysplasia was 22.9.

WATS-3D is effective at increasing the diagnostic yield of IM and dysplasia in BE patients after EET when used as an adjunct to FB sampling.