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Because the Seattle Protocol for biopsying the oesophagus, may miss vital cells, CDx Diagnostics has developed the Wide-area trans-epithelial sampling of the esophagus with computer-assisted three-dimensional analysis (WATS3D) which uses a brush inserted via the emdoscope to take samples over a large area.
From a paper published in Diseases of the Esophagus, December 2020, Clinical utility of wide-area transepithelial sampling with three-dimensional computer-assisted analysis (WATS3D) in identifying Barrett’s esophagus and associated neoplasia, "We demonstrate that WATS3D has high clinical utility. By prompting physicians to change their clinical management in patients with negative FB results, WATS3D, used adjunctively to FB, directly impacts patient management, and improves patient outcomes.
The sampling brush.
View through endoscope.
From SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) 2020, "Currently, WATS3D is not recommended as a stand-alone substitute for cold forcep biopsies. Forcep biopsy still offers the ability to sample specific areas of concern within the esophagus. Because the WATS3D system samples larger sections of the esophagus (compared to specific locations offered by forcep biopsy), gastroenterologists or surgeons may find it difficult to identify where a biopsy specimen may have come from in relation to the gastroesophageal junction.(1) Most studies have utilized the proximal gastric folds as the landmark for the gastroesophageal junction, however, this structure is dynamic, changing position with respiration, gut motor activity, and distention of the stomach and esophagus. Some patients diagnosed with BE may have intestinal metaplasia of the cardia. These concerns are inherent in the learning curve of a new device. Further research into the use of the WATS3D system as an independent screening or diagnostic modality may be warranted."
From the UK NICE guidelines, Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management, published 8 February 2023, "Balloon brushing is an old technique that is not currently used in clinical practice. Limited evidence on cytology obtained from balloon brushing showed it could detect oesophageal dysplasia and adenocarcinoma, but the committee agreed there was insufficient evidence to recommend its use in clinical practice."
Page updated 11 February 2023
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