Wide-area transepithelial sampling in adjunct to forceps biopsy increases the absolute detection rates of Barrett’s oesophagus and oesophageal dysplasia: a meta-analysis and systematic review

Abstract

BackgroundWide-area transepithelial sampling (WATS) is a new technique that uses an abrasive brush to obtain samples from a larger surface area of the oesophagus. Studies have shown promising results that WATS in adjunct to forceps biopsy (FB) increases the detection rate of Barrett’s oesophagus (BE) as well as oesophageal dysplasia (ED). We conducted a systematic review and meta-analysis to compare the detection rates of BE and ED between FB and WATS in adjunct to FB.MethodsA Literature search was done using electronic databases, including PubMed, Embase, Scopus, Cochrane and CINAHL from inception to 26 April 2020. A meta-analysis comparing detection rates of WATS in adjunct to FB versus FB using the random-effects model was done using RevMan V.5.3.ResultsPooled data from 20 392 endoscopies across 11 studies showed an absolute increase in detection of 16% (95% CI 0.10% to 0.22%, p<0.00001). A relative increase of 1.62 was seen in detection rates of BE (95% CI 1.28 to 2.05, p<0.0001) when WATS was used with FB with the number needed to test (NNT) of 6.1 patients. For ED, a 2% absolute increase (95% CI 0.01 to 0.03, p=0.001) in additional diagnostic yield from WATS. A relative increase of 2.05 was seen in the detection rate of ED (95% CI 1.42 to 2.98, p=0.0001) yielding an NNT of 50 patients.ConclusionOur study shows that WATS, as an adjunct to FB, improves both the absolute detection rate and relative detection rate of both BE and ED as compared to FB alone.

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

“…In this low-risk population, HGD was not detected in any patients by FBs; however, WATS 3D detected a single case of EAC missed by FBs ( 30 ). A recent meta-analysis also strongly supported the adjunctive use of WATS 3D to FB in BE screening and surveillance ( 33 ).…”

Barrett's esophagus: The pathomorphological and molecular genetic keystones of neoplastic progression

“… 80 Several studies demonstrated that WATS significantly improved the detection of both BE and esophageal dysplasia (Table 2 ). 80 , 81 , 82 , 83 , 84 , 85 Thus, in a prospective multicenter community‐based study enrolling 12,899 patients, Smith MS et al 80 showed that adding WATS to routine forceps biopsy raised the yield of dysplasia detection from 0.68% to 2.33% and increased the overall detection of dysplasia by 242% (95% CI 191%–315%). Rate of BE detection by forceps biopsy was 13.1% and WATS raised it to 33% increasing the overall detection of BE by 153% (95% CI 144%–162%).…”

Beyond Seattle: WATS and Advanced Imaging in Barrett’s Esophagus

“…19 A recent systematic review and meta-analysis with pooled data from 20 392 endoscopies across 11 studies also showed significant increases in detection of both BE and dysplasia when WATS was used in addition to FB. 35 A study by Raphael et al 36 evaluated whether there was any adjunctive yield of WATS-3D for dysplasia detection after advanced imaging (with HDWLE + NBI + VLE) plus Seattle protocol biopsies, and revealed that WATS-3D gave an added yield of 34.3%. WATS-3D also appears to be cost-effective when screening for BE based on a recent analysis.…”