Mo1272 WIDE-AREA TRANSEPITHELIAL SAMPLING IN ADJUNCT TO FORCEPS BIOPSY INCREASES THE DIAGNOSTIC YIELD OF RECURRENT OR RESIDUAL BARRETT’S ESOPHAGUS IN PATIENTS WHO UNDERWENT ENDOSCOPIC TREATMENT: A META-ANALYSIS AND SYSTEMATIC REVIEW

Abstract

Wide-Area Transepithelial Sampling (WATS) is a novel technique that uses an abrasive brush to obtain samples from a larger surface area of the esophagus as compared to forceps biopsy (FB). Analysis of this specimen is done with specialized computer imaging using neuronal networks optimized to identify esophageal tissue. WATS, in adjunct to FB, has shown to increase the detection rate of Barrett’s esophagus (BE) as well as Esophageal Dysplasia (ED). However, it’s utility in identifying recurrent or residual BE patients who have undergone endoscopic treatment for BE is limited. We conducted a systematic review and meta-analysis to compare the detection rates of BE between FB and WATS in adjunct to FB in such patients. A Literature search was done from electronic databases, including PubMed, Embase, Scopus, Cochrane, and CINAHL from inception until 11/2019 assisted by an expert librarian at our university. Data were extracted from studies and abstracts compared WATS in adjunct to FB versus FB in patients undergoing surveillance endoscopies after undergoing endoscopic treatment for BE. Endoscopic treatment included either radiofrequency ablation (RFA) or liquid nitrogen spray cryotherapy (SCT). A meta-analysis using a random-effects model was done using RevMan 5.3. Pooled data from 289 endoscopies across four studies for BE were analyzed. Our primary outcomes were relative and absolute increase in detection rates. 68 lesions were detected by FB alone with additional 42 lesions identified by FB plus WATS leading to a significant 63% relative increase [RR 1.63, 95%CI (1.28, 2.08), P< 0.0001] and a significant 13% Absolute increase [RD 0.13, 95% CI(0.06, 0.20), P= 0.0006] in detection with Number Needed to test(NNT) of 7.7 patients (Fig 1& 2). Our study shows that WATS, as an adjunct to FB, improves both the absolute detection rate and relative detection rate of BE compared to FB alone in patients undergoing surveillance post endoscopic treatment for BE. WATS, in adjunct to FB, can be used to guide treatment to achieve complete eradication of intestinal metaplasia (CEIM). Although our study showed a promising trend in absolute detection rates of ED, it was not significant. Data were insufficient for computing post-treatment surveillance using WATS as an adjunct to FB with only two available studies; these warrants further multicenter prospective studies to evaluate the diagnostic benefit of WATS in ED. Furthermore, a cost-effectiveness analysis is required before it can be routinely adopted into day to day practice. There were limitations to our study, including the usage of data from heterogeneous practice settings and non-randomization. The length of BE and the number of patients who had achieved CEIM after treatment was unclear; thus, residual and recurrent BE could not be analyzed individually.