Multicenter randomized controlled trial comparing forceps biopsies to wide-area transepithelial sampling brush for detecting intestinal metaplasia and dysplasia during routine upper endoscopy.

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Gastrointestinal endoscopy


oregon; portland; ppmc


INTRODUCTION: Intestinal metaplasia (IM) in the esophagus is a potentially pre-malignant mucosal change. The aim of this study was to compare the frequency of IM detection during upper endoscopy by forceps biopsy (FB) versus wide-area transepithelial sampling (WATS) brush.

METHODS: Patients presenting for upper endoscopy for foregut symptoms or surveillance of Barrett's esophagus (BE) at 9 centers in the United States were randomized to either FB or WATS.

RESULTS: There were 1002 patients. Biopsies were done in 505 and WATS in 497 patients. The overall frequency of finding IM was 21% and was similar with FB (19.6%) and WATS (22.7%, p=0.2). Low-grade dysplasia was found in 8 patients. No patient had high-grade dysplasia. There was no difference in detection of dysplasia between FB and WATS. In patients with no history of IM, WATS found significantly more IM compared with biopsies when a columnar-lined esophagus (CLE) was present (32.4% with WATS vs 15.2% with FB, p=0.004). In 184 patients with known BE, FB and WATS found IM with similar frequency (38.5% FB vs 41.9% WATS, p=0.6) with no difference whether the BE was short- or long-segment.

CONCLUSIONS: Overall, FB and WATS detect a similar frequency of IM and dysplasia. WATS was twice as likely as FB to find IM in patients without a history of BE who had CLE on endoscopy. In patients with known BE, WATS and FB showed IM and dysplasia with similar frequency. These findings suggest that WATS can be used instead of FB with similar or improved efficacy at detecting IM and dysplasia.

Clinical Institute

Digestive Health