WATS3D versus forceps biopsy in screening for Barrett's esophagus: experience in community endoscopy centers

Background Barrett's esophagus (BE) is a premalignant condition diagnosed using systematic 4-quadrant forceps biopsies (FB) during endoscopy. This method is fraught with errors due to the randomness of sampling and variability among operators. Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS(3D)) is an emerging technique used to collect esophageal samples. The aim of this study was to evaluate WATS(3D) as a diagnostic tool for detecting BE in addition to FB, compared to FB alone. Methods A retrospective observational cohort study was conducted and included patients who underwent screening for BE with WATS(3D) and FB between January 2015 and January 2019 across 3 endoscopy centers in Wichita, Kansas. The FB specimens were reviewed by community pathologists, while the WATS(3D) samples were sent to CDX technology labs, NY. Results A total of 108 patients were screened for BE using both modalities concurrently. FB and WATS(3D) detected 62 (57.4%) and 83 (76%) cases of BE, respectively. The absolute difference of 21 cases (18.6%) of BE was attributed to the addition of WATS(3D). The number needed to test with WATS(3D) was 5. We divided the sample into 4 groups to compare the agreement across all groups: (FB-; WATS(3D)+), (FB-; WATS(3D)-), (FB+; WATS(3D)+), and (FB+ and WATS(3D)-). Overall agreement by kappa statistic was 0.74. Conclusion WATS(3D) identified 21 cases of BE missed by FB. Using WATS(3D) in addition to FB increased the yield of BE during surveillance endoscopy, with no increase in complications.