Mo1265 WATS TESTING INCREASES DETECTION OF RECURRENT INTESTINAL METAPLASIA FOLLOWING COMPLETE ERADICATION OF INTESTINAL METAPLASIA IN TREATED BARRETT’S ESOPHAGUS WITH LOW-GRADE DYSPLASIA, HIGH-GRADE DYSPLASIA, OR INTRAMUCOSAL ADENOCARCINOMA

Abstract

Wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis (WATS, CDx Diagnostics, Suffern, NY) uses brush sampling to evaluate histologic features of a wide area of mucosa. A limited literature describes its yield for intestinal metaplasia (IM) in surveillance after successfully treated dysplastic Barrett’s esophagus (BE). To determine the additional yield for IM of WATS testing in addition to forceps biopsy (FB) in surveillance of BE following endoscopic treatment achieving complete eradication of intestinal metaplasia (CEIM). The WATS Registry is an ongoing multicenter U.S. study enrolling subjects undergoing WATS as part of usual care at 13 sites. Patients are aged 18 to 80 and are enrolled in one of three categories: diagnostic endoscopy for heartburn or regurgitation symptoms without a history of BE, surveillance endoscopy for already-diagnosed BE without prior endoscopic eradication therapy, or surveillance endoscopy for BE following eradication therapy. We analyzed all surveillance endoscopy visits for treated BE following CEIM. CEIM was defined as an endoscopy with negative FB for IM, negative WATS for IM (if taken), and no treatment given. We plotted product-limit estimates and Poisson models of the rate of recurrence of intestinal metaplasia using only the FB results to define recurrence compared with using both the FB and WATS testing results to define recurrence. In total, 384 endoscopies were performed for follow-up of treated Barrett’s esophagus with low-grade dysplasia, high-grade dysplasia, or intramucosal adenocarcinoma. Of these 384, 318 had CEIM, and 252 had one or more surveillance endoscopies at risk for recurrence (Table). The addition of WATS to FB increased the estimated rate of recurrence by rate ratio of 3.6 (95% confidence limits 2.0 – 6.0) (Figure). Among the 38 recurrences detected first or only on WATS, an irregular z-line was described in 9, one or more centimeters of columnar mucosa in 4, and a targeted FB was collected in 20. There were 16 recurrences detected on FB. Among the 38 WATS recurrences, concurrent cardia brushings or biopsies were available for 10, of which, 3 had IM of the cardia. The addition of WATS testing to FB substantially increased the detection of recurrent IM after eradication of BE with dysplasia or intramucosal carcinoma. Errant detection of cardia IM is not the likely source for most of these brushes, given that only 30% of those with cardia sampled separately showed IM of the cardia. The clinical implications and mechanisms of detecting recurrence on WATS testing versus FB remain uncertain, however, this increased detection of IM could have important implications for surveillance of treated BE.FigureProduct-limit estimate of the proportion of participants with recurrence of intestinal metaplasia detected by forceps biopsy alone compared to forceps biopsy and wide area transepithelial sample biopsy with three-dimensional computer-assisted analysis by time in years after the first registry visit with complete eradication of intestinal metaplasia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)