3106 Cirrhosis and Barrett's? WATS-3D as a Screening Tool

Abstract

INTRODUCTION: Barrett's esophagus (BE) is a pre-malignant condition in patients with long-standing GERD. The gold standard for diagnosing BE is taking 4-quadrant esophageal biopsies during endoscopy followed by demonstration of intestinal metaplasia on histopathology. However, in patients with cirrhosis, taking biopsies is rendered difficult due to an increased risk of bleeding due to esophageal varices and coagulopathy. This case series reports three patients with cirrhosis that were successfully diagnosed with BE using WATS3D (Wide angle trans-epithelial sampling with computer assisted 3 dimensional tissue analysis). CASE DESCRIPTION/METHODS: Case 1: 66 year-old female with a history of cirrhosis secondary to autoimmune hepatitis, esophageal varices, GERD and previously diagnosed BE that had liver and kidney transplants 3 years prior to presentation. Case 2: 63 year-old male with a history of BE, Laennec's cirrhosis, esophageal varices and portal hypertensive gastropathy. Case 3: 62 year-old male with a history of cirrhosis due to untreated hepatitis C and alcohol abuse, known carrier for HFE gene, GERD and BE. Case 1 and 2 had WATS3D brushings and mucosal biopsies, while Case 3 had WATS3D brushings alone due to concerns of bleeding. The findings are described in Table 1. There was agreement between the WATS3D analysis and biopsy results in the 2 patients. The patient with WATS3D brushings alone had evidence of goblet cell metaplasia. There were no immediate or post-procedural complications (bleeding, infections) in any of the patients. DISCUSSION: Review of literature suggests that the prevalence of GERD and neoplastic progression in patients with cirrhosis is higher compared to patients without liver disease. However, weighing the benefits and risks of taking biopsies during EGD, many cases of BE go undetected when physicians refrain from taking biopsies and rely solely on endoscopic findings. WATS3D uses a minimally invasive brush biopsy that resects wide area tissue samples, allowing analysis of the full trans-epithelial thickness of the esophagus. It is less invasive than forceps biopsy, has a higher sampling yield, and would be safer in patients at high risk of bleeding complications in patients similar to those presented in this case report.