Su1453 Evaluation of Wide-Area Transepithelial Sampling (Wats-3D) Brush Biopsy and Standard Forceps Biopsy (FB) for the Surveillance of Barrett's Dysplasia or Neoplasia After Endoscopic Therapy

Evaluation of Wide-Area Transepithelial Sampling (Wats-3D) Brush Biopsy and Standard Forceps Biopsy (FB) for the Surveillance of Barrett’s Dysplasia or Neoplasia After Endoscopic Therapy Danielle Marino*, Donald N. Tsynman, Vivek Kaul Gastroenterology, University of Rochester Medical Center, Rochester, NY Background: Endoscopic ablation is the standard treatment for Barrett’s esophagus (BE) with dysplasia. Post-ablation, the current standard includes surveillance endoscopy with four-quadrant FB every1-2cm of neo-squamous epithelium. However, dysplasia can be patchy in distribution and may be missed with standard FB protocol. A novel tissue sampling device, the WATS-3D computer-assisted brush-biopsy was developed to overcome sampling related limitations. It obtains a sample of the entire thickness of the squamous or glandular epithelium down to the lamina propria. A computer-assisted scan pinpoints potentially abnormal cells for presentation to a pathologist. This study serves to examine the incremental value of WATS sampling over standard FB for Barrett’s and dysplasia surveillance in patients after endoscopic ablation for dysplastic Barrett’s. Materials And Methods: In this pilot study, 13 charts were reviewed retrospectively over a 2 month period to identify patients with a history of BE with dysplasia or neoplasia who had previously undergone endoscopic therapy (mucosal resection, radiofrequency ablation or cryotherapy), and had a follow-up endoscopy with both standard biopsy and WATS. Demographic data, social/medical history and tissue sampling results from both modalities were collected. WATS results were compared for both concordance and discordance with standard pathology results. Study was IRB approved. Results: 12 patients met all inclusion criteria. One of the WATS samples was inadequate for interpretation, and thus 11 patients are included in the final analysis. The mean patient age was 79 years; 91% were male, 91% were Caucasian. 55% had long segment and 45% had short segment BE prior to therapy. Prior to endoscopic therapy, 6 patients had low-grade dysplasia (LGD), 5 patients had high-grade dysplasia (HGD), 1 patient had both LGD and HGD and 3 patients had intramucosal carcinoma. On follow-up endoscopy, 2 patients had residual BE on both WATS and FB specimens. 3 patients were diagnosed with BE on WATS only, (1 of these also had LGD by WATS only). No patients were diagnosed with BE on FB only. One patient was diagnosed with LGD on FB only, and one was diagnosed with HGD on FB only; both of the WATS samples showed nondysplastic BE. Overall, WATS increased the yield for BE and/or dysplasia in 27% (3/11) patients. There were no complications. Conclusions: In this pilot study of post endoscopic therapy surveillance, WATS increased the detection rate for BE and/or dysplasia by 27% when used as an adjunctive technique to 4 quadrant FB. However, FB did reveal dysplasia in 2 patients in which WATS was “normal”. Prospective studies, larger patient cohorts and standardized sampling protocols are needed to further assess this promising new technology.