WATS^3D versus forceps biopsy in screening for Barrett's esophagus: experience in community endoscopy centers

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.

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.

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.

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.