University of Kansas School of Medicine Wichita, KS, United States
Sachin Srinivasan, MD1, William J. Salyers, MD, MPH1, Amit Aravapalli, MD2, Matthew J. McKinley, MD3 1University of Kansas School of Medicine, Wichita, KS; 2Tryon Medical Partners, Charlotte, NC; 3ProHealth Care Associates, Lake Success, NY
Introduction: The clinical significance of intestinal metaplasia (IM) in the GEJ region of community patients without Barrett's Esophagus (BE) is controversial. Despite guideline recommendations, many community gastroenterologists continue to biopsy the GEJ region in GERD patients, especially when the Z line is irregular appearing. This cohort study aimed to evaluate the clinical impact on patient management when IM or dysplasia is found at the GEJ by WATS3D, but not by FB.
Methods: Patients enrolled in an IRB-approved community-based registry study between 2020 and 2021, identified as having IM or dysplasia at the GEJ by WAT3D but not by FB, and no endoscopic evidence of BE were identified. As part of the registry protocol, gastroenterologists performed these biopsies at their discretion. In addition, they completed a questionnaire to determine if the WATS3D-only diagnosis of IM or dysplasia resulted in a change of patient management, such as enrollment in surveillance, initiation or increase in PPI therapy, or performance of surgery or ablation. The decision to change therapy was also at the endoscopist’s discretion.
Results: This study included a total of 987 consecutive patients (mean age 61 yrs, M/F ratio 42%) with GEJ-IM (n=973) or dysplasia (n=14) detected by WATS3D but not FB. Overall, a WATS3D only diagnosis of IM directly impacted patient management in 85% of patients. For instance, 79% were either started on or had an increase in the dosage of PPI therapy, 94% were initiated into a surveillance program, and 1% had ablation or were referred for anti-reflux surgery. All 14 (100%) patients with dysplasia (indefinite, low, or high grade) had their management changed (14 were started on or had an increased dosage of PPI therapy, 9 initiated into surveillance, and 2 had surveillance frequency modified). There were no differences in change of patient management between patients with IM or dysplasia detected in an irregular vs. normal, appearing Z line at endoscopy.
Discussion: Even though the current guidelines do not support performing WATS3D or FB of the GEJ in GERD patients, regardless of the Z-line's contour, many community gastroenterologists continue to do so. Additionally, physician confidence in a WATS3D positive, but FB negative, diagnosis of IM or dysplasia is high since gastroenterologists change patient management due to this finding in the majority of instances.
Sachin Srinivasan indicated no relevant financial relationships.
William Salyers indicated no relevant financial relationships.
Amit Aravapalli indicated no relevant financial relationships.
Matthew McKinley indicated no relevant financial relationships.
Sachin Srinivasan, MD1, William J. Salyers, MD, MPH1, Amit Aravapalli, MD2, Matthew J. McKinley, MD3. P0327 - High Clinical Impact of WATS3D Positive, but Forceps Biopsy Negative, Diagnoses at the Gastro-Esophageal Junction in Community Patients With GERD, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.