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)

Background Barrett'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-naive 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). Methods This 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. Results In 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%). Conclusions WATS-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.