P4902 - Progression of Barrett’s Esophagus and Dysplasia Diagnosed by Wide-Area Transepithelial Sampling With 3-Dimensional Computer-Assisted Analysis (WATS3D): Results of Long-Term Follow-Up

Natalie J. Wilson, MD¹, Michael S.. Smith, MD, MBA², Matthew J. McKinley, FACG³, Arvind Trindade, MD⁴, William J.. Salyers, MD, MPH⁵, Vivek Kaul, MD, FACG⁶, Robert D. Odze, MD⁷, Nicholas J. Shaheen, MD, MPH, MACG⁸
1University of Minnesota, Minneapolis, MN; 2Icahn School of Medicine at Mount Sinai, New York, NY; 3NYU Langone Health, Bethpage, NY; 4Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ; 5University of Kansas School of Medicine - Wichita, Wichita, KS; 6University of Rochester Medical Center, Rochester, NY; 7Tufts University, Boston, MA; 8University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: WATS3D, used as an adjunct to forceps biopsy (FB) for Barrett’s esophagus (BE) sampling, increases the yield of dysplasia and intestinal metaplasia (IM). However, the risk of neoplastic progression in WATS3D-diagnosed BE is poorly understood.

We aimed to evaluate the risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in the largest cohort to date of WATS3D-diagnosed columnar-lined esophagus without IM (non-IM CLE), nondysplastic BE (NDBE), indefinite (IND)/crypt dysplasia (CD), and low-grade dysplasia (LGD).

Methods: This was a retrospective study of patients undergoing WATS3D from 2013-2024. Data were collected from the WATS3D commercial database (CDx Diagnostics, Suffern, NY). Patients with ≥1 cm CLE and at least one follow-up endoscopy ≥12 months from index WATS3D were included. Patients with prior dysplasia or endoscopic therapy for BE were excluded.

The primary outcome was the rate of progression to HGD/EAC (detected by either WATS3D or FB) stratified by baseline WATS3D histology. Progression rate was reported as percentage/patient-year for each baseline histologic category.

Results: Of 337,206 patients undergoing WATS3D, 30,782 met inclusion criteria (Table 1). Overall, 76 progressed to HGD/EAC over a mean of 3.35 years (range, 1.0-17.92). Progression was detected in 37 patients by FB and 66 by WATS3D. The progression rate to HGD/EAC, as detected by FB, was 0.19%/pt-yr in NDBE, 1.0% in IND/CD, and 3.41% in LGD (Table 2). In comparison, the progression rate as detected by WATS3D was 0.10%, 0.32%, and 1.86% in NDBE, IND/CD, and LGD, respectively. Differences in progression rates as detected by WATS3D and FB were statistically significant in those with baseline NDBE (p=0.004) and baseline IND/CD (p=0.02) but not in those with LGD (p=0.43) or non-IM CLE (p=0.16). Increasing age, male sex, white race, and longer BE segment were more common in progressors vs. nonprogressors (Table 1).

Discussion: In this largest reported cohort to date, patients with LGD detected by WATS3D progressed to BE/EAC at similar rates whether detected by FB or WATS3D, with rates comparable to those previously reported for FB-diagnosed LGD. Progression rates were somewhat lower in WATS3D-diagnosed NDBE and IND/CD when the outcome was measured by WATS3D compared to FB. Progression rates in non-IM CLE were miniscule. These data suggest that LGD diagnosed by WATS3D should trigger the same treatment as that recommended for FB‑detected LGD.


Figure: Table 1. Demographics and baseline endoscopic features, stratified by progression to high-grade dysplasia/esophageal adenocarcinoma detected by WATS3D


Figure: Table 2. Progression rates to HGD/EAC in patients with ≥1 cm CLE based on index WATS to outcome WATS (A) and index WATS to outcome FB (B)

Disclosures:
Natalie Wilson indicated no relevant financial relationships.
Michael Smith: Castle Biosciences – Consultant. CDx Diagnostics – Consultant. Lucid Diagnostics – Consultant. Provation Software – Consultant. Sanofi – Consultant. Steris Endoscopy – Consultant.
Matthew McKinley indicated no relevant financial relationships.
Arvind Trindade: Exact Sciences – Consultant, Grant/Research Support. Lucid Diagnostics – Consultant, Grant/Research Support.
William Salyers indicated no relevant financial relationships.
Vivek Kaul indicated no relevant financial relationships.
Robert Odze: CDx Medical – Consultant.
Nicholas Shaheen: Aqua – Grant/Research Support. CDx – Grant/Research Support. Cook Medical – Consultant. GIE Medical – Grant/Research Support. Interpace Diagnostics – Grant/Research Support. Lucid Diagnostics – Grant/Research Support. Medtronic – Grant/Research Support. Pentax – Grant/Research Support. Steris – Grant/Research Support.

Natalie J. Wilson, MD¹, Michael S.. Smith, MD, MBA², Matthew J. McKinley, FACG³, Arvind Trindade, MD⁴, William J.. Salyers, MD, MPH⁵, Vivek Kaul, MD, FACG⁶, Robert D. Odze, MD⁷, Nicholas J. Shaheen, MD, MPH, MACG⁸. P4902 - Progression of Barrett’s Esophagus and Dysplasia Diagnosed by Wide-Area Transepithelial Sampling With 3-Dimensional Computer-Assisted Analysis (WATS3D): Results of Long-Term Follow-Up, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.