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Published on: August 1, 2019
Multicenter randomized controlled trial comparing forceps biopsy sampling with wide-area transepithelial sampling
Steven DeMeester1, Chris Smith2, Paul Severson3
1The Oregon Clinic and Providence Portland Medical Center, Portland, Oregon, USA.
Insights
Wide-area transepithelial sampling (WATS) and forceps biopsy (FB) detect intestinal metaplasia (IM) similarly. WATS shows improved IM detection in specific patient groups during upper endoscopy.
Area of Science:
- Gastroenterology
- Oncology
- Endoscopic diagnostics
Background:
- Intestinal metaplasia (IM) is a premalignant esophageal condition.
- Accurate detection of IM is crucial for preventing esophageal adenocarcinoma.
- Current diagnostic methods include forceps biopsy (FB) and wide-area transepithelial sampling (WATS).
Purpose of the Study:
- To compare the diagnostic yield of IM detection using FB versus WATS.
- To evaluate the efficacy of WATS in detecting IM and dysplasia in patients undergoing upper endoscopy.
Main Methods:
- A randomized trial involving 1002 patients undergoing upper endoscopy.
- Patients were assigned to either FB or WATS for tissue sampling.
- Data on IM and dysplasia detection rates were compared between the two methods.
Main Results:
- Overall IM detection rates were similar between FB (19.6%) and WATS (22.7%).
- WATS detected significantly more IM than FB in patients without prior IM but with columnar-lined esophagus (32.4% vs 15.2%).
- Detection rates for IM and dysplasia were similar in patients with known Barrett's esophagus.
Conclusions:
- Both FB and WATS are effective in detecting IM and dysplasia.
- WATS may offer improved IM detection in specific patient populations, such as those with columnar-lined esophagus.
- WATS presents a viable alternative to FB for esophageal IM and dysplasia surveillance.
Background And Aims:
Intestinal metaplasia (IM) in the esophagus is a potentially premalignant mucosal change. The aim of this study was to compare the frequency of IM detection during upper endoscopy by forceps biopsy sampling (FB) versus wide-area transepithelial sampling (WATS) brush.
Methods:
Patients presenting for upper endoscopy for foregut symptoms or surveillance of Barrett's esophagus (BE) at 9 centers in the United States were randomized to either FB or WATS.
Results:
Of 1002 patients, FB was done in 505 and WATS in 497. The overall frequency of finding IM was 21% and was similar with FB (19.6%) and WATS (22.7%, P = .2). Low-grade dysplasia was found in 8 patients. No patient had high-grade dysplasia. There was no difference in detection of dysplasia between FB and WATS. In patients with no history of IM, WATS found significantly more IM compared with FB when a columnar-lined esophagus (CLE) was present (32.4% with WATS vs 15.2% with FB, P = .004). In 184 patients with known BE, FB and WATS found IM with similar frequency (38.5% FB vs 41.9% WATS, P = .6) with no difference in short- or long-segment BE.
Conclusions:
Overall, FB and WATS detected a similar frequency of IM and dysplasia. WATS was twice as likely as FB to find IM in patients without a history of BE who had CLE on endoscopy. In patients with known BE, WATS and FB showed IM and dysplasia with similar frequency. These findings suggest that WATS can be used instead of FB with similar or improved efficacy at detecting IM and dysplasia. (Clinical trial registration number: NCT03859557.).
