Detection of Barrett’s dysplasia using forceps biopsies vs. wide-area transepithelial sampling

We read with interest the article entitled “Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrettʼs esophagus: a multicenter randomized study” [1] published in Endoscopy. This is an important study aiding us in determining the role of wide-area transepithelial sampling (WATS) in surveillance of Barrett’s esophagus (BE). All included patients had an established diagnosis of BE-associated neoplasia, either flat low grade dysplasia (LGD) and high grade dysplasia (HGD), or flat BE with prior endoscopic resection of visible lesions of LGD, HGD, or low-risk mucosal esophageal adenocarcinoma with complete resection.

The Seattle protocol in obtaining biopsies in this study was followed by obtaining samples at 2-cm intervals. By following this protocol, forceps biopsies were negative in 18/39 patients who had positive WATS^3 D brush samples. While it is recommended to obtain samples at ≤ 2-cm intervals in nondysplastic BE, it is preferable to obtain four quadrant biopsy samples at 1-cm intervals, instead of 2-cm intervals, in dysplastic BE [2] [3]. Could sampling at 1-cm intervals have increased the detection of dysplasia by increasing the surface area sampled? Because all the patients enrolled in this study had BE-related neoplasia, doubling the number of samples by obtaining biopsies at 1-cm intervals might have increased the detection yield by forceps, which may have decreased the gap in patients who were WATS positive/forceps biopsy negative.

Additionally, WATS^3 D uses an abrasive brush to sample the entire surface area of the BE mucosa, which could theoretically alter the mucosal tissue structure. Therefore, could this have affected the yield of forceps biopsy sampling in the group where the WATS was obtained first and followed by forceps biopsy sampling? Addressing these two issues is of great importance in further deciding on the role of WATS in increasing dysplasia detection in BE. Future studies addressing the role WATS should include a follow-up examination for forceps biopsy sampling in WATS-positive samples to see if the additional dysplasia detected can be replicated by forceps sampling.

Publication History

Article published online:
26 October 2023

• References

• 1 van Munster SN, Leclercq P, Haidry R. et al. Wide-area transepithelial sampling with computer-assisted analysis to detect high grade dysplasia and cancer in Barrett's esophagus: a multicenter randomized study. Endoscopy 2023; 55: 303-310
• 2 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol 2016; 111: 30-50 , quiz 51
• 3 ASGE Standards of Practice Committee. Qumseya B, Sultan S. et al. ASGE guideline on screening and surveillance of Barrett's esophagus. Gastrointest Endosc 2019; 90: 335-359 e332