Endoscopy 2023; 55(04): 303-310
DOI: 10.1055/a-1949-9542
Original article

Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrettʼs esophagus: a multicenter randomized study

Sanne N. van Munster  ‡    *
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
2   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Philippe Leclercq‡    *
3   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
,
Rehan Haidry
4   Department of Gastroenterology and Hepatology, University Hospital London, London, UK
,
Helmut Messmann
5   Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
,
Andreas Probst
5   Department of Gastroenterology, University Clinics Augsburg, Augsburg, Germany
,
Krish Ragunath
6   Department of Gastroenterology and Hepatology, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
,
Pradeep Bhandari
7   Department of Gastroenterology and Hepatology, Queen Alexandra Hospital Solent Centre for Digestive Diseases, Portsmouth, UK
,
Alessandro Repici
 8   Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
 9   Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
,
Miguel Munoz-Navas
10   Department of Gastroenterology, University of Navarra Clinic. Pamplona, Spain
,
Stefan Seewald
11   Department of Gastroenterology and Hepatology, Hirslanden Private Clinic Group, Zurich, Switzerland
,
Arnaud Lemmers 
12   Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Glòria Fernández-Esparrach
13   Endoscopy Unit, Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
,
Oliver Pech
14   Department of Gastroenterology and Hepatology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
,
Erik J. Schoon
15   Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
16   GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
,
Revital Kariv
17   Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
,
Horst Neuhaus
18   Department of Gastroenterology and Hepatology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
,
Bas L. A. M. Weusten
2   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
19   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Peter D. Siersema
20   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Loredana Correale
21   Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
,
Sybren L. Meijer 
22   Department of Pathology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Gert de Hertogh
23   Translational Cell and Tissue Research Laboratory, KU Leuven, Leuven, Belgium
,
Jacques J.G.H.M. Bergman
1   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
,
Cesare Hassan   **
21   Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Rome, Italy
,
Raf Bisschops    **
3   Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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Referred to by:

Wide-area transepithelial sampling of Barrett’s epithelium: “WATS” the benefit?Endoscopy 2023; 55(04): 311-312
DOI: 10.1055/a-1995-5374

See also:

Detection of Barrett’s dysplasia using forceps biopsies vs. wide-area transepithelial samplingEndoscopy 2023; 55(11): 1055-1055
DOI: 10.1055/a-2094-7940

Abstract

Background Current surveillance for Barrett’s esophagus (BE), consisting of four-quadrant random forceps biopsies (FBs), has an inherent risk of sampling error. Wide-area transepithelial sampling (WATS) may increase detection of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). In this multicenter randomized trial, we aimed to evaluate WATS as a substitute for FB.

Methods Patients with known BE and a recent history of dysplasia, without visible lesions, at 17 hospitals were randomized to receive either WATS followed by FB or vice versa. All WATS samples were examined, with computer assistance, by at least two experienced pathologists at the CDx Diagnostics laboratory. Similarly, all FBs were examined by two expert pathologists. The primary end point was concordance/discordance for detection of HGD/EAC between the two techniques.

Results 172 patients were included, of whom 21 had HGD/EAC detected by both modalities, 18 had HGD/EAC detected by WATS but missed by FB, and 12 were detected by FB but missed by WATS. The detection rate of HGD/EAC did not differ between WATS and FB (P = 0.36). Using WATS as an adjunct to FB significantly increased the detection of HGD/EAC vs. FB alone (absolute increase 10 % [95 %CI 6 % to 16 %]). Mean procedural times in minutes for FB alone, WATS alone, and the combination were 6.6 (95 %CI 5.9 to 7.1), 4.9 (95 %CI 4.1 to 5.4), and 11.2 (95 %CI 10.5 to 14.0), respectively.

Conclusions Although the combination of WATS and FB increases dysplasia detection in a population of BE patients enriched for dysplasia, we did not find a statistically significant difference between WATS and FB for the detection of HGD/EAC as single modality.

 * Joint first authors.


** Joint last authors.


Supplementary material



Publication History

Received: 26 May 2022

Accepted after revision: 23 September 2022

Accepted Manuscript online:
23 September 2022

Article published online:
13 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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