SAN ANTONIO — Biopsies using a wide-area transepithelial sampling brush helped diagnose intestinal metaplasia in patients with no prior history, according to study results presented at the American College of Gastroenterology Annual Meeting.
“Studies have shown that adding WATS to biopsy increases the detection rate for dysplasia and cancer compared to biopsies alone, Steven DeMeester, MD, FACG, of The Oregon Clinic, said in his presentation. “The aim of this study was to compare the frequency of detection of intestinal metaplasia and dysplasia from biopsies versus WATS.”
In a multi-center trial, researchers randomly assigned patients presenting for upper endoscopy for foregut symptoms or Barrett’s surveillance to either biopsies (n = 509) or WATS brush (n = 493). They excluded any patients with a history of malignancy.
Investigators observed a columnar-lined esophagus (CLE) in 282 patients and the median length of CLE when present was 3 cm.
Both sampling methods had a similar frequency of finding intestinal metaplasia (19.45% in biopsies; 22.72% in WATS). In patients without any prior history of intestinal metaplasia, WATS found more metaplasia with an endoscopically visible length of CLE.
Additionally, DeMeester said the absence of CLE does not exclude patients from the risk for having intestinal metaplasia, dysplasia and cancer. In patients with no history of intestinal metaplasia, investigators identified low-grade dysplasia in two patients (one each in the biopsy and WATS groups) and found cancer in one patient. All three had no measurable CLE.
“Evaluation of the [gastroesophageal junction] by biopsy or WATS should be considered during every upper endoscopy, particularly in patients at risk for intestinal metaplasia,” DeMeester said. – by Alex Young
DeMeester S, et al. Abstract 33. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure s: DeMeester reports consulting for and receiving grant/research support from Bard/Davol and receiving grant/research support from CDx Diagnostics. Please see the study abstract for all other authors’ relevant financial disclosures.