WATS 3D Brush Biopsy Variability Compared to Traditional Forceps Biopsy in the Identification of Barrettʼs Esophagus and Dysplasia Diagnosis

Abstract

Introduction: Barrett's esophagus (BE) is a premalignant condition that requires surveillance to monitor for progression to dysplasia and esophageal adenocarcinoma. Wats 3D transepithelial biopsy (Wats3D) has been developed to augment traditional biopsy and with the intent to better detect dysplasia and esophageal adenocarcinoma. The aim of this study was to compare the variability of detection of Barrett's esophagus, degree of dysplasia and adenocarcinoma of Wats 3D brush biopsy to traditional forceps biopsy. Methods: 27 patients who have a clinical history of GERD and who had an EGD had both traditional forceps biopsies utilizing Seattle protocol and Wats 3D biopsy were identified. Any patient who had traditional biopsy but not Wats or vice versa were excluded. The results of identification of Barrett's esophagus, degree of dysplasia, or adenocarcinoma were compared between the two biopsy types using a Kappa coefficient Results: Kappa coefficient was calculated at 0.49 indicating moderate agreement between the two biopsy types (P=0.01, 95% confidence interval). Of the 27 patient's in the study 6 patients had Wats biopsy and forceps biopsies that did not agree. Of these six patient's, four patients (14.8%) had forceps biopsies that had more advanced pathology (low grade dysplasia vs barrett's in two cases, and barrett's vs no barrett's in two), while two patients (7.4%) had more advanced pathologic diagnosis with Wats 3D vs forceps biopsies. One of these patients had esophageal adenocarcinoma on Wats 3D but only Barrett's with high grade dysplasia on forceps biopsies Conclusion: Esophageal adenocarcinoma has a high mortality rate and a poor prognosis. As such screening for and surveillance of BE are critical in preventing progression. Wats transepithelial biopsy allows an endoscopist to obtain a wide area, full thickness biopsy and then a computer assisted 3D analysis is made in which the 200 of the most suspect cells and cell clusters are analyzed by a pathologist. By taking a wider biopsy with Wats technology, it stands to reason that the rate of detection of Barrett's esophagus and adenocarcinoma may be higher, or can at the very least be used to augment traditional biopsy for better detection rates. We found that there was a moderate amount of agreement between the two biopsy types. The data shows that while Wats 3D biopsy cannot replace traditional biopsies, the two can be combined to increase sensitivity when diagnosing Barrett's. It is our practice to treat the biopsy with the highest degree of severity in accordance with ACG guidelines. Overall, Wats should be considered an adjunct to traditional forceps biopsy in the screening and surveillance of patient's with Barret's.