LAUSR

BACKGROUND AND AIMS Seattle protocol forceps biopsies (FB) are currently recommended for surveillance in Barrett's esophagus (BE) but limited by sampling error and lack of adherence. Wide-area transepithelial sampling with 3D analysis (WATS-3D) is reported to increase BE dysplasia detection. We assessed the incremental yield and clinical significance of WATS-3D for dysplasia detection over FB in a systematic review and meta-analysis. METHODS We queried major scientific databases for studies using WATS-3D and FB from 2000-2020. Primary outcome was the incremental yield of WATS-3D detected dysplasia (defined as a composite of indefinite for dysplasia [IND], low- and high-grade dysplasia [LGD, HGD] and esophageal adenocarcinoma [EAC]) over FB. Secondary outcomes were incremental yields of HGD/EAC, and rate of reconfirmation of WATS-3D dysplasia on subsequent FB. RESULTS Meta-analysis of 7 eligible studies demonstrated that FB diagnosed dysplasia in 15.9% of cases, whereas incremental yield with WATS-3D was 7.2% (95% CI, 3.9%-11.5%; I2=92.1%). Meta-analysis of 6 studies demonstrated that FB diagnosed HGD/EAC in 2.3% of patients, whereas incremental yield with WATS-3D was 2.1% (95% CI, 0.4%-5.3%; I2=92.7%). Notably, WATS-3D was negative in 62.5% of cases where FB identified dysplasia. Two studies reported reconfirmation of WATS-3D dysplasia with FB histology in only 20 patients. CONCLUSION WATS-3D 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 WATS-3D are needed to determine the optimal clinical application and significance of WATS only dysplasia.