New brush biopsy method improves detection of BE-associated neoplasia

Last Updated: 2017-08-10

By Will Boggs MD

NEW YORK (Reuters Health) - Wide-area trans-epithelial sampling (WATS), combined with computer-assisted 3-dimensional analysis, significantly increases the detection of high-grade dysplasia and esophageal adenocarcinoma in people with Barrett's esophagus, according to results from a randomized trial.

"Current data suggest that <50% of all practicing endoscopists follow the Seattle biopsy protocol in Barrett's esophagus," Dr. Prateek Sharma from Veterans Affairs Medical Center, Kansas City, Missouri, and University of Kansas School of Medicine told Reuters Health by email. "These physicians will be greatly helped by the WATS sampling technique."

Barrett's esophagus (BE) can be a precursor of esophageal adenocarcinoma (EAC), so tissue changes are currently monitored through endoscopic surveillance with targeted biopsies of any visible lesions and the acquisition of random 4-quadrant biopsy specimens every 1 to 2 cm along the length of BE tissue (the Seattle protocol). Even this protocol can miss focal abnormalities that are located between sampled areas.

WATS is a brush biopsy technique that can be used to sample an extensive area of BE tissue.

Dr. Sharma and colleagues evaluated the use of WATS as an adjunct to biopsy for detecting high-grade dysplasia (HGD)/EAC in a referral population of 160 patients with BE from 16 US medical centers.

Seventy-six patients underwent biopsy followed by WATS, and 84 patients underwent the procedures in the opposite order, according to the July 28 Gastrointestinal Endoscopy online report.

Among individuals with negative biopsies, the addition of WATS led to the diagnosis of an additional 23 cases of HGD/EAC, an absolute increase of 14.4 percentage points. Eleven of these had been classified by biopsy as non-dysplastic BE; the rest were classified as low-grade dysplasia or indefinite.

Only 1 case of HGD/EAC was missed by WATS and classified as low-grade dysplasia.

The yield of HGD/EAC was fourfold higher with WATS than with the Seattle protocol, and the order of procedure did not affect the overall yield.

The use of WATS added an average of 4 minutes, 31 seconds, to the average 6 minutes, 55 seconds, required for the Seattle protocol biopsy.

Dr. Sharma anticipates that WATS will be used as "an adjunct to biopsies." He recommends that physicians "perform a careful examination of the Barrett's esophagus during endoscopy and target and biopsy any visible lesions."

Mindy Mintz Mordecai, President and CEO of ECAN Esophageal Cancer Action Network, Inc., whose husband died from esophageal cancer, told Reuters Health by email, "This is critically important. Being able to find four times as many cases of pre-cancerous Barrett's esophagus or early-stage cancer means many more lives will be saved. With a WATS 3D diagnosis, patients are able to take advantage of new treatments that can stop the development of esophageal cancer, sometimes even before it starts."

"The survival rate for esophageal cancer is dismally low today, largely because we rarely catch it soon enough to save a patient's life," she said. "Increasing by a factor of four our ability to diagnose and treat patients early should make a significant difference in survival."

"But we still have so many patients who experience persistent reflux disease and don't even know they are at risk," Mordecai said. "Making sure we have the best tools to find and eradicate the problem for those patients who do get checked is a huge first step. Now we must get more of the other at-risk patients who are currently unaware in for a WATS 3D exam!"

Five of the 23 authors report relationships with CDx Diagnostics, manufacturer of the brush biopsy kits for WATS.

SOURCE: http://bit.ly/2vpRGPl

Gastrointest Endosc 2017.