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 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.