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CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(04): E394-E402
DOI: 10.1055/a-1783-9015
Review

Surveillance of Barrett’s esophagus using wide-area transepithelial sampling: systematic review and meta-analysis

Bashar Qumseya
1   Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
,
Aymen Bukannan
2   Archbold Gastroenterology Group, Thomasville, Georgia, United States
,
Robyn Rosasco
3   Florida A & M University, 334 Palmer Ave, Tallahassee, Florida, United States
,
Xiuli Liu
4   Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, United States
,
Amira Qumseya
5   Department of Public Health, University of Florida, Gainesville, Florida, United States
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Abstract

Background and study aims Wide-area transepithelial sampling (WATS) is an emerging technique that may increase dysplasia detection in Barrett’s esophagus (BE). We conducted a systematic review and meta-analysis of patients who underwent surveillance for BE assessing the additional yield of WATS to forceps biopsy (FB).

Methods We searched Pubmed, Embase, Web of science, and the Cochrane library, ending in January 2021. The primary outcomes of interest were the relative and absolute increase in dysplasia detection when adding WATS to FB. Heterogeneity was assessed using I2 and Q statistic. Publication bias was assessed using funnel plots and classic fail-safe test.

Results A total of seven studies were included totaling 2,816 patients. FB identified 158 dysplasia cases, whereas WATS resulted in an additional 114 cases. The pooled risk ratio (RR) of all dysplasia detection was 1.7 (1.43–2.03), P < 0.001, I 2 = 0. For high-grade dysplasia (HGD), the pooled RR was 1.88 (1.28–2.77), P = 0.001, I 2 = 33 %. The yield of WATS was dependent on the prevalence of dysplasia in the study population. Among studies with high rates of dysplasia, the absolute increase in dysplasia detection (risk difference, RD) was 13 % (8 %-18 %, P < 0.0001, number needed to treat [NNT] = 8). The pooled RD in HGD was 9 % (2 %-16 %), P < 0.001, NNT = 11. For studies with a low prevalence of dysplasia, RD for all dysplasia was 2 % (1 %-3 %), P = 0.001, NNT = 50. For HGD, the RD was 0.6 % (0.2 %-1.3 %), P = 0.019, NNT = 166.

Conclusions In populations with a high prevalence of dysplasia, adding WATS to FB results in a significant increase in dysplasia detection.

Supplementary material



Publication History

Received: 09 June 2021

Accepted after revision: 10 November 2021

Article published online:
14 April 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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