Role of Wide-Area Transepithelial Sampling With 3D Computer-Assisted Analysis in the Diagnosis and Management of Barrett's Esophagus

Abstract

Barrett's esophagus (BE) is a premalignant condition in which cancer prevention is performed by endoscopic surveillance combined with Seattle protocol mucosal biopsies. The Seattle protocol has significant limitations, including a high rate of sampling error due to the focality of dysplasia/carcinoma, low endoscopist adherence to the protocol, and a high degree of variability in pathologic interpretation. These factors all contribute to a high incidence of cancers missed within 1 year of surveillance endoscopy. Wide-area transepithelial sampling with computer-assisted three-dimensional analysis (WATS 3D ) is a relatively new technique that minimizes sampling error by using a brush biopsy device that extensively samples “at risk” mucosa and helps pathologists diagnose dysplasia/neoplasia by generating three-dimensional images of whole crypts using a neural network-based software program. Several large prospective trials (involving both academic and community practices) have shown significantly increased rates of detection of dysplasia and intestinal metaplasia in both screening and surveillance in patients with BE when used as an adjunct to Seattle protocol-based forceps biopsies. The WATS 3D diagnostic platform was included in the most recent American Society for Gastrointestinal Endoscopy Barrett's guideline as an adjunct to forceps biopsies (conditional recommendation and low quality of evidence). This review summarizes the scientific and pathologic basis of WATS 3D technology, its potential impact on BE surveillance and management, and its limitations and future directions.

Advanced endoscopic imaging for detection of Barrett’s esophagus

“…Typically, WATS-3D specimens are sent to CDx Diagnostics to be evaluated by expert pathologists who receive specialized training in this modality. 17 Multiple meta-analyses have evaluated that WATS-3D demonstrates an incremental yield in diagnosing dysplasia. 13,18 The most recent meta-analysis conducted by Suresh Kumar et al in 2020 18 evaluated 11 studies comparing WATS-3D and FB to FB alone.…”

Meta-analysis of related factors of premature ovarian failure based on computer

“…Its specific steps include determining the theme of Meta-analysis, collecting relevant literature, formulating strict inclusion and exclusion criteria, evaluating the quality of included literature, extracting and summarizing relevant literature information, sorting and analyzing data, reporting results and conclusions, etc. In order to further clarify the influencing factors of the disease and determine the degree of correlation between these factors and the disease, this study searched [2][3]. As shown in Figure 1:…”

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“…This technology provides many cross-sectional images, and future artificial intelligence studies may help process these images ( 14 , 15 ). Sequential sampling biopsies, such as the Seattle protocol, and wide-area transepithelial sampling (WATS) may also help detect dysplasia and early cancer ( 16 , 17 ).…”