361 WATS3D vs. Traditional Forceps Biopsy in Screening of Barrett’s Esophagus: A Community Hospital Experience

Abstract

INTRODUCTION: Barrett’s esophagus (BE) is a pre-malignant condition of the esophagus currently diagnosed using systematic 4-quadrant cold forceps biopsies during endoscopy. Demonstration of intestinal metaplasia on histopathology and the degree of dysplasia is the cornerstone of BE diagnosis and management. This current method of biopsy is fraught with errors due to the randomness of sampling and experience of the operator. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique to collect esophageal samples and improve detection of BE. We compared WATS3D with traditional biopsy as a screening tool in BE. METHODS: We reviewed the charts of adult patients that underwent BE screening by 3 of our gastroenterologists involved in the study with WATS3D and traditional cold forceps biopsy (FB) over the last year across community hospitals in Wichita, KS. The biopsy specimens were processed and analyzed by in-house pathologists while the WATS3D specimen were sent to CDX technology labs, NY. WATS3D specimens were obtained after FB in all instances. RESULTS: A total of 108 patients were identified to have undergone both WATS3D and FB at the same time for BE screening. FB detected 62 cases (57.4%) while WATS3D detected 83 (76%) cases of BE. This attributed to an absolute increase in 21 cases (18.6%) of incident BE detection by WATS3D. The number needed to test (to detect an additional patient with BE) with WATS3D was 5. We divided the sample into 4 groups – WATS3D+FB+, WATS3D+FB-, WATS3D-FB+, WATS3D-FB- to compare the agreement across the 4 groups (Table 1). Overall agreement by kappa statistic was 0.74 (good). There were 62 and 23 cases that were identified as positive and negative respectively by both methods. The pathologist read both cases of FB+ that was WATS3D- as intestinal metaplasia with no dysplasia. Of the 21 cases that were FB-, WATS3D identified 15 cases of goblet cell metaplasia, 4 cases of crypt dysplasia, 1 case of low-grade dysplasia and 1 case of adenocarcinoma. There were no immediate complications reported among the patients studied. CONCLUSION: WATS3D identified 20 cases of BE missed by FB, including 1 case of low-grade dysplasia and 1 case of adenocarcinoma. It is possible that the cases missed by WATS3D were due to the presence of an island of BE that was removed during FB. Overall, with no added increase in complications, WATS3D improved incident detection of BE compared to FB alone.