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

Bashar Qumseya; Aymen Bukannan; Robyn Rosasco; Xiuli Liu; Amira Qumseya

doi:10.1055/a-1783-9015

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

Endosc Int Open. 2022 Apr 14;10(4):E394-E402. doi: 10.1055/a-1783-9015. eCollection 2022 Apr.

Authors

Bashar Qumseya¹, Aymen Bukannan², Robyn Rosasco³, Xiuli Liu⁴, Amira Qumseya⁵

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States.
² Archbold Gastroenterology Group, Thomasville, Georgia, United States.
³ Florida A & M University, 334 Palmer Ave, Tallahassee, Florida, United States.
⁴ Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, United States.
⁵ Department of Public Health, University of Florida, Gainesville, Florida, United States.

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 I ² 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.

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/).

Publication types

Review