Don C. Codipilly, MD1, Apoorva Chandar, MD2, Lovekirat Dhaliwal, MBBS1, David A. Katzka, MD1, Kenneth K. Wang, MD, FACG3, Amitabh Chak, MD4, Prasad G. Iyer, MD, MS1; 1Mayo Clinic, Rochester, MN; 2University Hospitals Cleveland Medical Center, Cleveland, OH; 3Mayo Clinic College of Medicine, Rochester, MN; 4University Hospitals of Cleveland, Cleveland, OH
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 2011-2020), 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. Discussion: 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.
Disclosures: Don Codipilly indicated no relevant financial relationships. Apoorva Chandar indicated no relevant financial relationships. Lovekirat Dhaliwal indicated no relevant financial relationships. David Katzka: Erbe – Advisory Committee/Board Member. Kenneth Wang indicated no relevant financial relationships. Amitabh Chak: LucidDx – Advisory Committee/Board Member, Consultant, Employee, Grant/Research Support, Patent Holder, Speaker's Bureau, Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support. Steris – Advisory Committee/Board Member, Consultant, Employee, Grant/Research Support, Patent Holder, Speaker's Bureau, Stockholder/Ownership Interest (excluding diversified mutual funds), Other Financial or Material Support. Prasad Iyer: Exact Science – Grant/Research Support. Medtronic – Consultant, Grant/Research Support. Nine Point Medical – Grant/Research Support. Pentax Medical – Grant/Research Support. Symple Surgical – Advisory Committee/Board Member.