Retrospective, observational, cross-sectional study of detection of recurrent Barrett’s esophagus and dysplasia in post-ablation patients with adjunctive use of wide-area transepithelial sample (WATS-3D)

Hala Fatima; Maryiam Wajid; Nour Hamade; Yan Han; William Kessler; John Dewitt; Douglas Rex; Thomas Imperiale

Authors Hala Fatima, Maryiam Wajid, Nour Hamade, Yan Han, William Kessler, John Dewitt, Douglas Rex, Thomas Imperiale.

Abstract

Background Barrett’s esophagus (BE) and dysplasia are often missed by Seattle protocol biopsies (SPB). Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS- 3D) with SPB improves detection in treatment-naïve patients. We aimed to determine to what extent WATS-3D adds to SPB in the detection of non-dysplastic BE (NDBE) and dysplasia in patients undergoing post-endoscopic eradication therapy (EET).

Methods This retrospective, observational, cross-sectional study included patients who presented for post-EET surveillance with SPB and WATS-3D sampling from April 2019 to February 2020. BE patients with no previous EET were excluded. For the outcomes of NDBE and any dysplastic/ neoplastic finding, we calculated both relative and absolute increases in yield by WATS-3D over SBP.

Results In 78 patients [mean age 68±10.4 years, 66 (84.6%) male], the prevalence of NDBE, any dysplastic/neoplastic finding, and any abnormality (NDBE or dysplasia/neoplasia) were 53.85%, 10.26%, and 55.13%. The absolute increase in yield of NDBE with WATS-3D over SPB was 26.9% (95% confidence interval [CI] 17.95-37.18%), with the number needed to treat (NNT) 3.71 (95%CI 2.69-5.57) and a relative increase in yield of 100% (95%CI 53.33-188.25%). For dysplasia/neoplasia, the absolute increase in yield was 6.4% (95%CI 1.28-12.82%), NNT 15.6 (95%CI 7.8-78.0), and relative increase of 167% (95%CI 33.33%-infinity). For any abnormal finding, the absolute increase in yield was 26.9% (95%CI 16.67-37.18%), NNT 3.71 (95%CI 2.69-6.00), and relative increase in yield 95% (95%CI 50-176.92%).

Conclusions WATS-3D with SPB improves the detection of residual/recurrent BE and dysplasia in post-ablation BE. However, randomized controlled trials are needed to validate these findings.

Keywords Barrett’s esophagus, Seattle protocol, dysplasia, detection, post-endoscopic eradication therapy

Ann Gastroenterol 2022; 35 (2): 113-118