S0405 Wide Area Transepithelial Sampling in Adjunct to Forceps Biopsy in Post Treatment Barret’s Esophagus: Increasing Diagnostic Yield

Abstract

INTRODUCTION: Previous studies have shown that WATS-3D as an adjunct to both targeted and random FB increases the diagnostic yield for the detection of dysplasia. However, till date, there have been no published studies that assess the use of WATS-3D after endoscopic ablation or endoscopic mucosal resection (EMR). The aim of this study is to evaluate whether the addition of WATS-3D to standard FB would improve the yield of detecting intestinal metaplasia, dysplasia or carcinoma in patients undergoing post-ablation/EMR surveillance endoscopy and if this changes the medical management. METHODS: A single center, retrospective cohort study was conducted. Consecutive patients undergoing WATS-3D procedure after post-ablation between 2018 and 2019 with a known prior history of BE with low-grade dysplasia (LGD), high-grade dysplasia (HGD), and/or intramucosal adenocarcinoma (IMCA) were included. Data was collected on endoscopic information, pathologic evaluation of slides, and other demographic variables. RESULTS: A total of 37 subjects with a confirmed history of BE with a prior endoscopic intervention underwent EGD with FB and WATS-3D sampling. Biopsies from FB and WATS-3D were compared: negative for dysplasia or positive for metaplasia/dysplasia (Table 2). The readings were concordant on both FB and WATS-3D in 28/37 subjects or 75.6% of the samples. One additional case was detected only by FB showing LGD, representing a yield of FB alone of 2.7%. Eight additional cases were detected only by WATS-3D. Seven of them showed intestinal metaplasia and one showed indefinite for dysplasia. This increment represents an increased yield of detected metaplasia of 350% (=7/2) with WATS-3D. The absolute increase of 7 cases of metaplasia, results in a number needed to treat (NNT) of 37/7 = 5.2. Three of those additional 8 cases detected by WATS-3D, had an increase in the interval of follow-up (Table 3). The former constitutes a change in management of 37.5% of those additional 8 cases. CONCLUSION: Our study shows that WATS-3D as an adjunct to FB increases the diagnostic yield for the detection of intestinal metaplasia in patients undergoing post-ablation/resection surveillance endoscopy by 350% (=7/2) (NNT: 5.2). In addition, WATS-3D had a direct impact of change in the medical management with closer follow up in 37.5% of those additional 8 cases. Further multicenter prospective studies are needed to evaluate the diagnostic benefit of WATS-3D in surveillance endoscopies.Table 1.: Clinical and demographic characteristics of subjects with BE (n = 37)Table 2.: Forceps biopsy and WATS-3D biopsy reads: negative for dysplasia, positive for metaplasia or dysplasiaTable 3.: Interval of follow-up and change in management