Most patients with recurrent BE after initially successful RFA achieve second CE-IM; however, 1.8% progressed to invasive adenocarcinoma. Longer Prague M was predictive of invasive adenocarcinoma. Four-quadrant random biopsy of the cardia is advisable during surveillance endoscopy after CE-IM.

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Background: Wide area trans-epithelial sampling (WATS) is a technique that allows sampling of a larger surface area and may increase dysplasia detection rates in Barrett's esophagus (BE). We aimed to conduct a systematic review and metaanalysis of patients with BE who underwent endoscopy comparing the diagnostic yield of endoscopy forceps biopsies (FB) to WATS. Methods: The search was done with the help of an expert librarian and included Pubmed, Embase, Web of science, and Cochrane library from inception to 10/2017. Studies and recent abstracts (presented 2015-2017) were included if they used WATS in addition to FB for screening or surveillance in patients with BE. Studies were imported into "covidence.org" and screened by two independent reviewers. The primary outcome was the absolute increase in dysplasia detection on WATS compared to FB. Secondary outcomes were the proportional increase in diagnostic yield and the number needed to treat (NNT). Results: were stratified by patient population: history of dysplasia vs. no history of dysplasia. Heterogeneity was assessed using I 2 and Q statistic. Publication bias was assessed using funnel plots. Results: of 1437 studies, 6 studies (5 manuscripts, 1 abstract), totalling 6271 patients, were included in the final analysis. There were 5 multicenter prospective trials and a single randomized trial. Half the studies included patients with a prior history of dysplasia (Table ). Only one study seprated LGD from HGD. Among patients with history of dysplasia, random effects models showed that the absolute increase in dysplasia detection by adding WATS was 6.5% [2.6 -10.4%], p<0.001, NNT Z15. No significant heterogeneity was noted (I 2 Z0, QZ1.1). There was no evidence of publication bias on funnel plots or classic fail-safe test. Random effects models with matched analysis showed that the proportional increase of dysplasia detection was 42.4% [23.6 -61.2%], p<0.001. Among studies in patients with no history of dysplasia, random effects models showed that the absolute increase in dysplasia detection by adding WATS to FB was 3.4% [1.3 -5.6%], pZ0.002, NNT Z29. Significant heterogeneity was noted (I 2 Z83%, QZ11.6). There was no evidence of publication bias on funnel plots. Random effects models showed that the proportional increase of dysplasia detection was 49.2% [22.6 -75.7%], p<0.001 (Figure). Discussion: WATS has received increasing attention with varying outcomes reported by different investigators. This evidence-based analysis attempted to standardize the outcomes and reported them based on systematic review of the literature. WATS increased detection of dysplasia in absolute (3.4-6.5%) and proportional measures (42.4-49.2%). Future prospective multicenter studies are needed that address the diagnostic yield of HGD/EAC in a non-enriched population before widespread adoption of WATS can be recommended.