P0326 - Evaluation of Intestinal Metaplasia and Dysplasia in GERD Patients With an Irregular versus Normal Appearing Z-Line by Forceps Biopsy and WATS3D

Sachin Srinivasan, MD¹, Matthew J. McKinley, MD², Amit Aravapalli, MD³, William J. Salyers, MD, MPH⁴, Robert Odze, MD^5
1University of Kansas School of Medicine, Olathe, KS; ²ProHealth Care Associates, Lake Success, NY; ³Tryon Medical Partners, Charlotte, NC; ⁴University of Kansas School of Medicine, Wichita, KS; ⁵Robert Odze, Boston, MA

Introduction: The clinical significance of intestinal metaplasia (IM) in GERD patients with < 1.0 cm esophageal columnar mucosa and an “irregular “appearing squamous-columnar junction (“Z” line) is controversial and relatively unknown. The prevalence rate of GEJ cancers is on the rise and likely related to very short segments of esophageal IM. The use of forceps biopsies (FB) to detect IM is fraught with sampling error. This study aimed to evaluate and compare the clinical and pathologic features of GERD patients with irregular vs. normal-appearing Z line at endoscopy.



Methods: Patients enrolled in an IRB-approved clinical WATS3D registry (CDx Diagnostics, Suffern, NY), where EGD with FB and WATS3D was performed for GERD, were included. At endoscopy, the decision to biopsy was made by the gastroenterologist independent of the registry & societal guidelines. The appearance and location of the Z-line was noted and correlated with clinical and pathologic features, including the presence of IM (goblet cells) and dysplasia by FB and/or WATS3D. The adjunctive and absolute yield of WATS3D was calculated.

Results: A total of 5599 consecutive patients (mean age 56 yrs, M/F ratio 75%), accrued between 2020-2021, were included. 74% patients had an irregular, and 26% had a normal-appearing Z line at the GEJ region. Overall, 1858(33%) patients had IM (detected by FB and/or WATS3D), but a significantly higher percentage occurred in the irregular Z line group (35% vs. 28%, P< 0.001). The adjunctive and absolute yield of WATS3D was 156% and 20%, respectively. Overall, 40 patients (0.75%) had either indefinite, low, or high-grade dysplasia, and although more occurred in the irregular Z line group (N=31 vs. 9), this difference was not significant (adjunctive yield of WATS3D dysplasia detection was 52%). Significantly more patients with an irregular Z line had Barrett’s-like features - male sex, age >55 years, white race, hiatus hernia, and active esophagitis, than the normal Z line group (all P < 0.05).

Discussion: With the addition of WATS3D to FB, which minimizes sampling error and increases adjunctive yield, the prevalence rate of IM and dysplasia at the GEJ region in this large cohort study was 33% and 0.75 %, respectively. GERD patients with an irregular Z line (demonstrating < 1cm of esophageal columnar mucosa) may constitute a subgroup who are at a higher risk of progression, but this needs to be evaluated further.


Disclosures:


Sachin Srinivasan, MD¹, Matthew J. McKinley, MD², Amit Aravapalli, MD³, William J. Salyers, MD, MPH⁴, Robert Odze, MD⁵. P0326 - Evaluation of Intestinal Metaplasia and Dysplasia in GERD Patients With an Irregular versus Normal Appearing Z-Line by Forceps Biopsy and WATS3D, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.