Wide-area Transepithelial Sampling Research Articles

Adjunctive Use of WATS-3D in Symptomatic GERD Patients Increases Detection of Barrett's Esophagus and Dysplasia.

Patients with gastroesophageal reflux (GERD) symptoms undergoing screening upper endoscopy for Barrett's esophagus (BE) frequently demonstrate columnar-lined epithelium (CLE), with forceps biopsies (FB) failing to yield intestinal metaplasia (IM). Repeat endoscopy is often necessary. Assess the yield of IM leading to a diagnosis of BE by the addition of Wide-Area Trans-epithelial Sampling (WATS-3D) to FB in the screening of GERD patients. We performed a prospective registry study of GERD patients undergoing screening upper endoscopy. Patients had both WATS-3D and FB. Patients were classified by their Z line appearance: regular, irregular (<1 cm CLE), possible short-segment BE (1-<3cm), and possible long-segment BE (≥3cm). Demographics, IM yield, and dysplasia yield were calculated. Adjunctive yield was defined as cases identified by WATS-3D not detected by FB, divided by cases detected by FB. Clinicians were asked if WATS-3D results impacted patient management. Of 23,933 patients, 6,829(28.5%) met endoscopic criteria for BE. Of these, 2,878(42.1%) had IM identified by either FB or WATS-3D. Among patients fulfilling endoscopic criteria for BE, the adjunctive yield of WATS-3D was 76.5%, and absolute yield was 18.1%. 1,317 patients (19.3%) who fulfilled endoscopic BE criteria had IM detected solely by WATS-3D. Of 240 patients with dysplasia, 107(44.6%) were found solely by WATS-3D. Among patients with positive WATS-3D but negative FB, the care plan changed in 90.7%. The addition of WATS-3D to FB in GERD patients being screened for BE resulted in confirmation of BE in an additional 1/5 th of patients. Furthermore, dysplasia diagnoses approximately doubled.

WATS 3D : An Interobserver Study of Barrett's Esophagus-Associated Dysplasia Among Gastrointestinal Pathologists.

Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS 3D ) has been shown to increase the detection rate of dysplasia (and intestinal metaplasia) in patients with Barrett's esophagus (BE). The purpose of this study was to evaluate the interobserver variability and accuracy of diagnosing BE-associated dysplasia in WATS 3D specimens among gastrointestinal (GI) pathologists without prior experience with this technology. Five GI pathologists underwent a 4-hour in-person (at microscope) and virtual training session and then evaluated digital images of discrete cellular foci from 60 WATS 3D cases with BE (20 nondysplastic BE [NDBE], 20 low-grade dysplasia [LGD], and 20 high-grade dysplasia/esophageal adenocarcinoma [HGD/EAC]). Each case consisted of 1 hematoxylin and eosin-stained image (cell block), and 1 liquid cytology or papanicolaou-stained smear image (120 images in total). The overall kappa value among the 5 study pathologists was excellent (overall kappa = 0.93; kappa = 0.93 and 0.97 for cell block and smear specimens, respectively). There were no significant differences noted in kappa values in interpretation of the cell block vs smear specimens or in any of the individual diagnostic categories when the latter were evaluated separately. Furthermore, agreement was perfect (100%) regarding detection of neoplasia (either LGD, HGD, or EAC). Diagnoses were made with complete confidence in 91% of instances. We conclude that GI pathologists, without any prior experience in interpretation of WATS 3D specimens, can undergo a short training session and then diagnose these specimens with a very high level of accuracy and reproducibility.

Benefit of adjunctive wide-area transepithelial sampling with 3-dimensional computer-assisted analysis plus forceps biopsy based on Barrett’s esophagus segment length

Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS-3D) has been shown to increase the diagnostic yield of intestinal metaplasia (IM) and dysplasia within a segment of suspected or known Barrett's esophagus (BE) when used as an adjunct to forceps biopsies. Few data are available regarding how segment length affects WATS-3D yield. The purpose of this study was to evaluate adjunctive WATS-3D use in patients with varying lengths of BE. A total of 8471 patients (52.5% male; mean age, 63 years) enrolled in 2 registry studies were included in this study. All patients were being screened or surveyed for BE with both forceps biopsies and WATS-3D. The adjunctive and absolute yield of WATS-3D was calculated according to the length of the patient's BE segment. The overall adjunctive and absolute increased diagnostic yields with WATS-3D were 47.6% and 17.5%, respectively, for detection of IM, and 139% and 2.4% for detection of dysplasia. IM and dysplasia detection both increased with the use of WATS-3D regardless of segment length. Increase in IM diagnostic yield was significantly higher in short- versus long-segment cases but higher in long-segment cases for dysplasia detection. This study shows that when WATS-3D is added as an adjunct to forceps biopsies, it is effective at increasing the diagnostic yield of both BE and associated dysplasia in patients with both short and long segments of esophageal columnar-lined epithelium.

Wide-area transepithelial sampling of Barrett's epithelium: "WATS" the benefit?

Regular surveillance of Barrett’s esophagus (BE) is recommended by all leading gastroenterology societies worldwide [1] [2]. The rationale for such a strategy is supported by several retrospective studies that have demonstrated reduced esophageal adenocarcinoma (EAC)-related mortality and earlier stage diagnosis of cancer in patients receiving endoscopic monitoring as compared with patients not undergoing surveillance [3].

Utility of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis as an adjunct to forceps biopsy sampling in the surveillance of patients with Barrett’s esophagus after endoscopic eradication therapy

Utility of wide-area transepithelial sampling with 3-dimensional computer-assisted analysis as an adjunct to forceps biopsy sampling in the surveillance of patients with Barrett’s esophagus after endoscopic eradication therapy

S2257 Cirrhosis, Varices, and Barrett’s Esophagus: WATS3D-only Surveillance and Band Ligation in the Management of Nondysplastic Barrett’s Esophagus Progressing to High Grade Dysplasia With Underlying Esophageal Varices

Introduction: Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is an emerging technique used to collect esophageal samples via transepithelial brushing. WATS3D can be a safe and useful tool in Barrett’s esophagus (BE) management in patients with underlying small esophageal varices (EV) where traditional 4 quadrant cold forceps biopsies (CFB) would be contraindicated due to the risk of adverse events such as bleeding. We describe the utility of WATS3D-only surveillance combined with band ligation in the management and eradication of BE which progressed to high grade dysplasia (HGD) in a patient with underlying cirrhosis and EV. Case Description/Methods: We present a 66-year-old male with a history of nondysplastic (ND) BE (C0-M1), small Grade 1 EV and cirrhosis who presented for BE surveillance. Due to underlying EV and associated risk of bleeding, CFB was not performed and sampling with WATS3D-only was undertaken. WATS3D was first performed with surveillance esophagogastroduodenoscopy (EGD) in 2015 and demonstrated ND BE. On further EGD surveillance, BE histology remained ND until early 2021 where WATS3D revealed low grade dysplasia (LGD). Repeat EGD with WATS3D brushing was performed 4 months later, which demonstrated progression to HGD. Interval surveillance EGD with WATS3D brushing was, again, performed 4 months later and demonstrated LGD with rare foci of HGD. Of note, in both instances band ligation of the dysplastic segments was done. EGD with WATS3D 3 months later revealed endoscopic clearance of BE post-banding and pathology report revealed, ND, non-goblet cell metaplasia. The final interval surveillance EGD with WATS3D, 3 months later, showed complete eradication of BE with no evidence of intestinal metaplasia. Table 1 provides a thorough chronological description from first EGD to complete resolution of BE, 8 years later. Discussion: WATS3D has been increasingly shown to be an effective BE surveillance and screening tool. However, given the lack of data regarding appropriate surveillance windows for WATS3D-only BE surveillance, we performed sampling at shorter intervals than what would otherwise be recommended, to confirm the lack of dysplasia. This case presents a unique approach to WATS3D-only surveillance combined with band ligation therapy of dysplasia in the management of BE in a cirrhotic patient with underlying EV. Additionally, this case is unique in clearly documenting progression of a short segment of ND BE to HGD with WATS3D sampling alone. Table 1. - Summary of findings and intervention from first EGD to complete resolution of BE (8 year window) Date Variceal Grade Prague Score Number of BE Islands Sampling done by WATS3D Pathology Findings Banding therapy (# of bands) 04/09/14 2 C0-M1 3 No N/A 0 07/29/15 2 C0-M1 Scattered No N/A 0 12/2315 1 C0-M1 Scattered Yes No dysplasia 0 06/15/16 1 C0-M1 Scattered Yes No dysplasia 0 02/08/17 2 C0-M1 Scattered No N/A 4 01/22/18 1 C0-M1 1 No N/A 0 01/30/19 2 C0-M1 2 No N/A 0 01/29/20 1 C0-M1 2 No N/A 0 02/01/21 1 C0-M1 2 Yes Low-grade dysplasia 0 06/01/21 1 C0-M1 2 Yes High-grade dysplasia 3 10/25/21 1 C0-M1 2 Yes Low-grade with rare foci of high-grade dysplasia 2 01/25/22 1 N/A 3 Yes Non-goblet cell metaplasia, no dysplasia 0 04/25/22 1 N/A 0 Yes Squamocolumnar, no dysplasia or metaplasia 0

Multicenter Randomized Controlled Trial of Surveillance Versus Endoscopic Therapy for Barrett’s Esophagus With Low-grade Dysplasia: The SURVENT Trial: Study Rationale, Methodology, Innovation, and Implications

Multicenter Randomized Controlled Trial of Surveillance Versus Endoscopic Therapy for Barrett’s Esophagus With Low-grade Dysplasia: The SURVENT Trial: Study Rationale, Methodology, Innovation, and Implications

The concordance between wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) and standard endoscope biopsy in the detection of Barrett's esophagus and esophageal dysplasia

IntroductionBarrett's esophagus (BE) is a premalignant condition that leads to susceptibility to developing adenocarcinoma. The most common endoscopic surveillance technique is forceps biopsy, which involves sampling the specimen every 1 to 2 cm along the length of the lesion. This technique has a low sensitivity and often leaves the majority of the esophageal mucosa untested. Recently, the use of wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) has received much attention. However, there is little known about this novel technique, and this research aims to add to our knowledge of WATS-3D by comparing it to traditional forceps biopsy. Materials and methodsA retrospective observational study was performed. All existing GI biopsy cases diagnosed with WATS-3D were identified from the institutional pathology databases of NYU Langone Hospital - Long Island from 2019 to 2021. Data collection included patients' age, sex, and dysplasia results. Existing pathology reports and CDx diagnostics were reviewed. All the existing slides of the biopsy cases were pulled out and reviewed. Dysplasia was classified as no dysplasia, indefinite for dysplasia, lowgrade dysplasia, and high-grade dysplasia. ResultsA total of 109 cases were included in this study. There are 59 cases diagnosed as BE with forceps biopsy, 72 cases by WATS-3D, and 77 cases by WATS-3D combined with forceps biopsy. The sensitivity of detecting BE was significantly increased by WATS-3D and further by WATS-3D combined with forceps biopsy. In 59 cases diagnosed as BE with forceps biopsy, 50 cases were classified as no dysplasia, 3 cases were indefinite for dysplasia, 5 cases were low-grade dysplasia, and 1 case was high-grade dysplasia. In 72 cases diagnosed as BE by WATS-3D, 64 cases were classified as no dysplasia, 7 cases were indefinite for dysplasia, 1 case was high-grade dysplasia, and no cases with low-grade dysplasia. In 77 cases diagnosed as BE by WATS-3D combined with forceps biopsy, 63 cases were classified as no dysplasia, 8 cases were indefinite for dysplasia, 5 cases with low-grade dysplasia, and 1 case was highgrade dysplasia. The maximal longitudinal extent of the esophageal mucosal changes strongly correlated with the severity of BE. ConclusionCompared to traditional forceps biopsy, WATS-3D was more sensitive in finding intestinal metaplasia. However, WATS-3D could not clearly discriminate low-grade dysplasia from indefinite for dysplasia and tended to classify low-grade dysplasia as indefinite for dysplasia. The addition of WATS-3D to forceps biopsy resulted in an increase in diagnostic yield and thus an increase in the quality of patient care.

Surveillance of Barrett's esophagus using wide-area transepithelial sampling: systematic review and meta-analysis.

Background and study aims Wide-area transepithelial sampling (WATS) is an emerging technique that may increase dysplasia detection in Barrett’s esophagus (BE). We conducted a systematic review and meta-analysis of patients who underwent surveillance for BE assessing the additional yield of WATS to forceps biopsy (FB). Methods We searched Pubmed, Embase, Web of science, and the Cochrane library, ending in January 2021. The primary outcomes of interest were the relative and absolute increase in dysplasia detection when adding WATS to FB. Heterogeneity was assessed using I 2 and Q statistic. Publication bias was assessed using funnel plots and classic fail-safe test. Results A total of seven studies were included totaling 2,816 patients. FB identified 158 dysplasia cases, whereas WATS resulted in an additional 114 cases. The pooled risk ratio (RR) of all dysplasia detection was 1.7 (1.43–2.03), P < 0.001, I 2 = 0. For high-grade dysplasia (HGD), the pooled RR was 1.88 (1.28–2.77), P = 0.001, I 2 = 33 %. The yield of WATS was dependent on the prevalence of dysplasia in the study population. Among studies with high rates of dysplasia, the absolute increase in dysplasia detection (risk difference, RD) was 13 % (8 %-18 %, P < 0.0001, number needed to treat [NNT] = 8). The pooled RD in HGD was 9 % (2 %-16 %), P < 0.001, NNT = 11. For studies with a low prevalence of dysplasia, RD for all dysplasia was 2 % (1 %-3 %), P = 0.001, NNT = 50. For HGD, the RD was 0.6 % (0.2 %-1.3 %), P = 0.019, NNT = 166. Conclusions In populations with a high prevalence of dysplasia, adding WATS to FB results in a significant increase in dysplasia detection.

Retrospective, observational, cross-sectional study of detection of recurrent Barrett's esophagus and dysplasia in post-ablation patients with adjunctive use of wide-area transepithelial sample (WATS-3D).

BackgroundBarrett’s esophagus (BE) and dysplasia are often missed by Seattle protocol biopsies (SPB). Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS-3D) with SPB improves detection in treatment-naïve patients. We aimed to determine to what extent WATS-3D adds to SPB in the detection of non-dysplastic BE (NDBE) and dysplasia in patients undergoing post-endoscopic eradication therapy (EET).MethodsThis retrospective, observational, cross-sectional study included patients who presented for post-EET surveillance with SPB and WATS-3D sampling from April 2019 to February 2020. BE patients with no previous EET were excluded. For the outcomes of NDBE and any dysplastic/neoplastic finding, we calculated both relative and absolute increases in yield by WATS-3D over SBP.ResultsIn 78 patients [mean age 68±10.4 years, 66 (84.6%) male], the prevalence of NDBE, any dysplastic/neoplastic finding, and any abnormality (NDBE or dysplasia/neoplasia) were 53.85%, 10.26%, and 55.13%. The absolute increase in yield of NDBE with WATS-3D over SPB was 26.9% (95% confidence interval [CI] 17.95-37.18%), with the number needed to treat (NNT) 3.71 (95%CI 2.69-5.57) and a relative increase in yield of 100% (95%CI 53.33-188.25%). For dysplasia/neoplasia, the absolute increase in yield was 6.4% (95%CI 1.28-12.82%), NNT 15.6 (95%CI 7.8-78.0), and relative increase of 167% (95%CI 33.33%-infinity). For any abnormal finding, the absolute increase in yield was 26.9% (95%CI 16.67-37.18%), NNT 3.71 (95%CI 2.69-6.00), and relative increase in yield 95% (95%CI 50-176.92%).ConclusionsWATS-3D with SPB improves the detection of residual/recurrent BE and dysplasia in post-ablation BE. However, randomized controlled trials are needed to validate these findings.

Multicenter randomized controlled trial comparing forceps biopsy sampling with wide-area transepithelial sampling brush for detecting intestinal metaplasia and dysplasia during routine upper endoscopy

Intestinal metaplasia (IM) in the esophagus is a potentially premalignant mucosal change. The aim of this study was to compare the frequency of IM detection during upper endoscopy by forceps biopsy sampling (FB) versus wide-area transepithelial sampling (WATS) brush. Patients presenting for upper endoscopy for foregut symptoms or surveillance of Barrett's esophagus (BE) at 9 centers in the United States were randomized to either FB or WATS. Of 1002 patients, FB was done in 505 and WATS in 497. The overall frequency of finding IM was 21% and was similar with FB (19.6%) and WATS (22.7%, P= .2). Low-grade dysplasia was found in 8 patients. No patient had high-grade dysplasia. There was no difference in detection of dysplasia between FB and WATS. In patients with no history of IM, WATS found significantly more IM compared with FB when a columnar-lined esophagus (CLE) was present (32.4% with WATS vs 15.2% with FB, P= .004). In 184 patients with known BE, FB and WATS found IM with similar frequency (38.5% FB vs 41.9% WATS, P= .6) with no difference in short- or long-segment BE. Overall, FB and WATS detected a similar frequency of IM and dysplasia. WATS was twice as likely as FB to find IM in patients without a history of BE who had CLE on endoscopy. In patients with known BE, WATS and FB showed IM and dysplasia with similar frequency. These findings suggest that WATS can be used instead of FB with similar or improved efficacy at detecting IM and dysplasia. (Clinical trial registration number: NCT03859557.).

Role of Wide-Area Transepithelial Sampling With 3D Computer-Assisted Analysis in the Diagnosis and Management of Barrett's Esophagus.

Barrett's esophagus (BE) is a premalignant condition in which cancer prevention is performed by endoscopic surveillance combined with Seattle protocol mucosal biopsies. The Seattle protocol has significant limitations, including a high rate of sampling error due to the focality of dysplasia/carcinoma, low endoscopist adherence to the protocol, and a high degree of variability in pathologic interpretation. These factors all contribute to a high incidence of cancers missed within 1 year of surveillance endoscopy. Wide-area transepithelial sampling with computer-assisted three-dimensional analysis (WATS3D) is a relatively new technique that minimizes sampling error by using a brush biopsy device that extensively samples “at risk” mucosa and helps pathologists diagnose dysplasia/neoplasia by generating three-dimensional images of whole crypts using a neural network-based software program. Several large prospective trials (involving both academic and community practices) have shown significantly increased rates of detection of dysplasia and intestinal metaplasia in both screening and surveillance in patients with BE when used as an adjunct to Seattle protocol-based forceps biopsies. The WATS3D diagnostic platform was included in the most recent American Society for Gastrointestinal Endoscopy Barrett's guideline as an adjunct to forceps biopsies (conditional recommendation and low quality of evidence). This review summarizes the scientific and pathologic basis of WATS3D technology, its potential impact on BE surveillance and management, and its limitations and future directions.

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Post-endoscopy Esophageal Neoplasia in Barrett’s Esophagus: Consensus Statements From an International Expert Panel

Progression of Barrett’s esophagus, crypt dysplasia, and low-grade dysplasia diagnosed by wide-area transepithelial sampling with 3-dimensional computer-assisted analysis: a retrospective analysis

Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS3D) is used as an adjunct to forceps biopsy sampling in Barrett's esophagus (BE). BE-associated crypt dysplasia (CD), which can be detected by WATS3D, involves crypts but not surface epithelium. The risk of neoplastic progression of CD has never been evaluated. The prognosis of WATS3D-diagnosed nondysplastic BE (NDBE) and low-grade dysplasia (LGD) is also unknown. We assessed the risk of progression of WATS3D-reported NDBE, CD, and LGD with high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). We analyzed patients who underwent WATS3D in routine care. Eligible patients had 2 WATS3D≥12 months apart. Patients were categorized by the initial WATS3D finding as NDBE, CD, or LGD. Patient-years of observation were calculated by multiplying the mean follow-up by the number of patients. Progression, defined as a subsequent finding of HGD/EAC on forceps biopsy sampling, was assessed. The crude progression rate was calculated, and Kaplan-Meier analysis compared progression rates stratified by baseline histology. Bivariate analysis identified progression risk factors. Of 151,224 WATS3D cases, 43,145 (29%) had BE. Of these, 4545 patients had 2 WATS3D separated by≥12 months. The mean follow-up was 1.97 years (range, 1.0-6.42). In patients with baseline NDBE, progression was .08% per patient-year (95% confidence interval [CI], .02%-.14%). Progression of baseline CD was significantly higher, at 1.42% per patient-year (95% CI, 0%-3.01%). For baseline LGD, progression was 5.79% per patient-year (95% CI, 1.02%-10.55%). Other risk factors for progression were increasing age and BE segment length. NDBE found on WATS3D has a very low risk of progression. CD reported on WATS3D appears to be a neoplastic precursor lesion, with a risk of progression in this study significantly higher than NDBE but lower than LGD. The clinical utility of CD requires further investigation.

Beyond Seattle: WATS and Advanced Imaging in Barrett’s Esophagus

Barrett’s esophagus is the sole known precursor for esophageal adenocarcinoma. Endoscopic surveillance for Barrett’s esophagus is recommended to help identify and manage dysplasia, with the ultimate goal being prevention or early detection of esophageal adenocarcinoma. The current standard of care for endoscopic surveillance for Barrett’s esophagus, the Seattle protocol, has many drawbacks. Methods to overcome these disadvantages have been an active area of research. This review will focus on some of the technologies to help improve dysplasia surveillance in Barrett’s esophagus, including advanced endoscopic imaging, artificial intelligence, and wide-area transepithelial sampling with computer-assisted 3D analysis (WATS-3D).

S0423 “WATS” the Incremental Yield of Wide-Area Transepithelial Sampling for Dysplasia Detection in Barrett’s Esophagus? A Systematic Review and Meta-Analysis

INTRODUCTION: Seattle protocol forceps biopsies (FB) are currently recommended for surveillance in Barrett’s esophagus (BE). Dysplasia detection is limited by sampling error. Wide-area transepithelial sampling (WATS) utilizes computer-aided diagnosis of esophageal brushings to increase dysplasia detection. We assessed the incremental yield of WATS compared to FB and limitations of published data in a systematic review and meta-analysis. METHODS: We queried multiple scientific databases for studies utilizing WATS with FB from 2000–2020. We utilized the arcsine transformation with a fixed-effects meta-analysis of single arm proportions for analysis given the small number of studies. Primary outcome was the incremental yield of WATS over FB for dysplastic BE (IND/LGD + HGD + EAC) as a composite. Secondary outcomes were incremental yield of WATS for HGD/EAC, and the rate of reconfirmation of incremental WATS dysplasia on subsequent FB. RESULTS: We included 6 full-length manuscripts (from 2011 to 2020), studying 37,468 patients (6 included data for dysplastic BE, and 4 for HGD/EAC), Study characteristics are shown in the Table. All WATS samples were read by pathologists at CDx Diagnostics (Suffern, NY). BE histology was confirmed by 2 expert GI pathologists in only 2 (33%) studies. Meta-analysis of 6 studies demonstrated that FB diagnosed dysplasia in 5.8% (95% CI: 5.1%–6.6%) of cases, while WATS added an incremental yield of 4.5% (95% CI: 3.9%–5.2%; Figure 1). Meta-analysis of 4 studies demonstrated that FB diagnosed HGD/EAC in 0.6% (95% CI 0.4%–0.9%) of patients, while WATS added an incremental yield of 0.4% (95% CI: 0.2%–0.6%; Figure 2). Notably, WATS was negative in 1%–45% of cases where FB identified dysplasia. Only 1 study reported reconfirmation of WATS dysplasia on subsequent endoscopy: only 7 of 23 (30%) WATS dysplasia (+) patients had dysplasia on subsequent FB. In 3 studies the incremental yield of WATS dysplasia was reported in several cases with FB histology negative for intestinal metaplasia (85% of cases). No endoscopic data was available in these cases. CONCLUSION: WATS appears to increase the yield of dysplastic BE and HGD/EAC as an adjunct to FB. However, in most studies, this incremental yield is not reconfirmed by FB, WATS reads are done only by CDx pathologists and FB dysplasia is not confirmed by expert GI pathologists. Long-term follow up is required to ascertain dysplasia outcomes in patients with dysplasia based solely on WATS.Figure 1Figure 2Table 1

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

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

Clinical utility of wide-area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D) in identifying Barrett's esophagus and associated neoplasia.

Sampling error during screening and surveillance endoscopy is a well-recognized problem. Wide-area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D), used adjunctively to forceps biopsy (FB), has been shown to increase the detection of Barrett's esophagus (BE) and BE-associated neoplasia. We evaluated the clinical utility of WATS3D and its impact on the management of patients with BE and dysplasia. Between 2013 and 2018, 432 consecutive patients who had a WATS3D positive and an accompanying FB negative result were identified. Physicians were contacted to determine if the WATS3D result impacted their decision to enroll patients in surveillance or increase the frequency of surveillance, recommend ablation, and/or initiate or increase the dose of proton pump inhibitors (PPIs). WATS3D directly impacted the management of 97.8% of 317 BE patients; 96.2% were enrolled in surveillance and 60.2% were started on PPIs or their dose was increased. WATS3D impacted the management of 94.9% and 94.1% of the 98 low-grade dysplasia and 17 high-grade dysplasia patients, respectively. As a result of WATS3D, 33.7% of low-grade dysplasia and 70.6% of high-grade dysplasia patients underwent endoscopic therapy. More than 37% of all dysplasia patients were enrolled in a surveillance program, and nearly 30% were scheduled to be surveilled more frequently. PPIs were either initiated, or the dose was increased in more than 54% of all dysplasia patients. We demonstrate that WATS3D has high clinical utility. By prompting physicians to change their clinical management in patients with negative FB results, WATS3D, used adjunctively to FB, directly impacts patient management, and improves patient outcomes.

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

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.

SAGES TAVAC safety and efficacy analysis WATS3D (CDx Diagnostics, Suffern, NY).

Wide-area transepithelial sampling of the esophagus with computer-assisted three-dimensional analysis (WATS3D, CDx Diagnostics, Suffern, NY) is an adjunctive technique to random biopsies for early detection of Barrett's esophagus. The aim of the SAGES Technology and Value Assessment Committee aims is to evaluate the efficacy, value, and safety of WATS3D. Clinical studies involving WATS3D were identified via a search of the PubMed/Medline databases ( www.ncbi.nlm.nih.gov/pubmed ) conducted in March of 2019 using search terms, such as wide-area transepithelial sampling, three-dimensional (3D) computer-assisted analysis, WATS-3D, Barrett's esophagus and WATS-3D, Barrett's esophagus and wide-area transepithelial sampling with three-dimensional computer-assisted analysis, Barrett's esophagus, and emerging technology. Bibliographies of key references were searched for relevant studies not covered by the PubMed search. Case reports and small case series were excluded. No significant morbidity or mortality was reported within the literature associated with the WATS3D technology. WATS3D increases diagnostic yield by 38-150% for Barrett's Esophagus, by 40-150% for Low Grade Dysplasia; and by 420% for High Grade Dysplasia; when compared to forceps biopsy alone. WATS3D technique has very high inter-observer agreement for the pathological diagnosis of non-dysplastic and dysplastic Barrett's Esophagus. Increased detection of pre-malignant diseases of the esophagus by the adjunctive use of WATS3D supports screening and surveillance by the adjunctive use of WATS3D during upper endoscopy in appropriate patients. Wide-area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D, CDx Diagnostics) is a safe and effective adjunct to forcep biopsies in the evaluation of Barrett's Esophagus, Low Grade Dysplasia, and High Grade Dysplasia.