443 Adjunctive Yield of Wide-Area Trans-Epithelial Sampling With Computer-Assisted Three-Dimensional Analysis in Detection of Dysplasia After Advanced Imaging and Random Biopsies in Barrett’s Esophagus

Abstract

INTRODUCTION: Wide-area trans-epithelial sampling with computer-assisted three-dimensional analysis (WATS-3D) has been used for dysplasia detection in endoscopic surveillance of Barrett’s esophagus (BE). Little is known about the additive yield of WATS after a thorough exam with advanced imaging that consists of high definition white light endoscopy (HDWLE), narrow band imaging (NBI), volumetric laser endomicroscopy (VLE) with laser marking, and Seattle protocol biopsies (collectively termed HDWLE-NBI-VLE-SP exam). The aim of this study was to evaluate the adjunctive yield of WATS-3D after an HDWLE-NBI-VLE-SP exam. METHODS: This is a single center observational cohort study from January 2017 to December 2018. Charts were abstracted for consecutive patients that underwent an advanced imaging exam. Raised lesions were removed by endoscopic resection. Areas suspicious for dysplasia on NBI and VLE were biopsied or resected. This was followed by random biopsies. Finally WATS-3D brush biopsies were performed. RESULTS: One hundred and thirty eight cases were included in this study. Thirty-five cases (25% of the total ) were identified as some degree of dysplasia on the HDWLE-NBI-VLE-SP exam. Of these, 14 were reported as indefinite for dysplasia, 11 low-grade dysplasia (LGD), 8 high-grade dysplasia (HGD) or intramucosal cancer, and 2 T1b cancers. Adjunctive use of WATS-3D yielded an additional 12 new cases of dysplasia (9 with crypt dysplasia and 3 with LGD), for added yield of 34.3% (=12/35, 95% CI 14.6-62.2%). In addition, 8 cases of dysplasia found on the HDWLE-NBI-VLE-SP exam were upgraded by WATS-3D to a higher grade of dysplasia (5 with crypt dysplasia and 3 with HGD). Thus the absolute increase provided by WATS was 8.7% (=12/138) for a new diagnosis of dysplasia and was 14.5% (=20/138) when combining both new and upgraded diagnosis of dysplasia grade. CONCLUSION: The addition of WATS-3D to an already thorough exam with HDWLE-NBI-VLE-SP can increase the yield of dysplasia detection.