Background and Aims

Seattle protocol forceps biopsy sampling (FB) is currently recommended for surveillance in Barrett’s esophagus (BE) but limited by sampling error and lack of compliance. Wide-area transepithelial sampling with 3-dimensional analysis (WATS3D; CDx Diagnostics, Suffern, NY, USA) is reported to increase BE dysplasia detection. We assessed the incremental yield and clinical significance of WATS3D for dysplasia detection over FB in a systematic review and meta-analysis.

Methods

We queried major scientific databases for studies using WATS3D and FB from 2000 to 2020. The primary outcome was the incremental yield of WATS3D-detected dysplasia (defined as a composite of indefinite for dysplasia, low- and high-grade dysplasia [HGD] and esophageal adenocarcinoma [EAC]) over FB. Secondary outcomes were incremental yields of HGD/EAC and rate of reconfirmation of WATS3D dysplasia on subsequent FB.

Results

Meta-analysis of 7 eligible studies demonstrated that FB diagnosed dysplasia in 15.9% of cases, whereas the incremental yield with WATS3D was 7.2% (95% confidence interval, 3.9%-11.5%; I² = 92.1%). Meta-analysis of 6 studies demonstrated that FB diagnosed HGD/EAC in 2.3% of patients, whereas the incremental yield with WATS3D was 2.1% (95% confidence interval, .4%-5.3%; I² = 92.7%). Notably, WATS3D was negative in 62.5% of cases where FB identified dysplasia. Two studies reported reconfirmation of WATS3D dysplasia with FB histology in only 20 patients.

Conclusions

WATS3D increases dysplasia detection; however, the clinical significance of this increased dysplasia detection remains uncertain. Data from endoscopic follow-up to ascertain FB histology in patients with dysplasia based solely on WATS3D are needed to determine the optimal clinical application and significance of WATS3D-only dysplasia.

中文翻译：

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用于 Barrett 食管异型增生检测的广域经上皮取样：系统评价和荟萃分析

背景和目标

西雅图协议钳活检取样 (FB) 目前被推荐用于巴雷特食管 (BE) 的监测，但受到取样错误和缺乏依从性的限制。据报道，采用 3 维分析（WATS3D；CDx Diagnostics，Suffern，NY，USA）的广域经上皮取样可增加 BE 异型增生检测。我们在系统回顾和荟萃分析中评估了 WATS3D 相对于 FB 的异型增生检测的增量产量和临床意义。

方法

我们查询了 2000 年至 2020 年间使用 WATS3D 和 FB 进行研究的主要科学数据库。主要结果是 WATS3D 检测到的异型增生（定义为不确定的异型增生、低级和高级异型增生 [HGD] 和食管腺癌 [EAC]）优于 FB。次要结果是 HGD/EAC 的增量产量和后续 FB 上 WATS3D 异型增生的再确认率。

结果

对 7 项符合条件的研究的荟萃分析表明，FB 在 15.9% 的病例中诊断出异型增生，而 WATS3D 的增量产量为 7.2%（95% 置信区间，3.9%-11.5%；I ² = 92.1%）。对 6 项研究的荟萃分析表明，FB 在 2.3% 的患者中诊断出 HGD/EAC，而 WATS3D 的增量产量为 2.1%（95% 置信区间，0.4%-5.3%；I ² = 92.7%）。值得注意的是，WATS3D 在 62.5% 的 FB 鉴定为发育异常的病例中呈阴性。两项研究报告仅在 20 名患者中用 FB 组织学再次证实了 WATS3D 异型增生。

结论

WATS3D 增加了异型增生检测；然而，这种异常增生检测增加的临床意义仍不确定。需要来自内窥镜随访的数据以确定仅基于 WATS3D 的异型增生患者的 FB 组织学，以确定仅 WATS3D 异型增生的最佳临床应用和意义。