S1260 Safety and Efficacy of Wide-Area Transepithelial Sampling With 3D Analysis (WATS-3D) in the Surveillance of Barrett’s Esophagus Among Patients With Esophageal Varices: A Case Series

Introduction: Surveillance of Barrett’s esophagus (BE) in patients with esophageal varices presents a clinical challenge due to the risk of significant bleeding with conventional 4-quadrant biopsies. In the absence of established guidelines for this high-risk population, we aimed to evaluate whether wide-area transepithelial sampling with 3D analysis (WATS-3D) offers a safer and effective alternative. Methods: We conducted a case series of 28 patients with esophageal varices and endoscopic evidence suggestive of BE. A total of 38 WATS-3D brushings were performed during routine endoscopies. Patients were subsequently monitored in the surgical center and outpatient clinic for adverse events. Approval to carry out the study was given by the University of Kansas Institutional Review Board (IRB). Results: The mean patient age was 67.5 years, with 23 males (82%) and a mean body mass index of 29.3. Two patients had a prior history of upper gastrointestinal bleeding, and 5 had a known diagnosis of BE. Most patients (n = 25) underwent WATS-3D brushing a single time. Three patients underwent multiple sessions; 2 had 2 brushings and the other underwent 9. The primary indications for endoscopy were variceal surveillance (59%), BE surveillance (11%), both (18%), and other indications (10%). Small varices were noted in 91% of cases, while 9% had large varices. Among the cases reviewed, 2 exhibited circumferential Barrett’s esophagus. The average length of the short segment Barrett’s was 1.62 cm, while long segment cases averaged 3.56 cm. WATS-3D identified Barrett’s mucosa in 47% of specimens (n = 18), with low-grade dysplasia found in 3 cases and high-grade dysplasia in 1. Non-goblet columnar epithelium was seen in 53% (n = 20). Median follow-up was 4 weeks, during which no patient experienced bleeding or hospitalization related to upper gastrointestinal bleeding. While no patients experienced bleeding during the procedure, 3 patients did undergo banding during the same session. Conclusion: In this cohort, WATS-3D was a safe and well-tolerated modality for BE surveillance in patients with esophageal varices. It enabled effective assessment of dysplasia while minimizing the bleeding risks associated with standard biopsy protocols.