Abstract
Optical coherence tomography (OCT) is uniquely poised for advanced imaging in the gastrointestinal (GI) tract as it allows real-time, subsurface and wide-field evaluation at near-microscopic resolution, which may improve the current limitations or even obviate the need of superficial random biopsies in the surveillance of early neoplasias in the near future. OCT’s greatest impact so far in the GI tract has been in the study of the tubular esophagus owing to its accessibility, less bends and folds and allowance of balloon employment with optimal contact to aid circumferential imaging. Moreover, given the alarming rise in the incidence of Barrett’s esophagus and its progression to adenocarcinoma in the U.S., OCT has helped identify pathological features that may guide future therapy and follow-up strategy. This review will explore the current uses of OCT in the gastrointestinal tract and future directions, particularly with non-endoscopic office-based capsule OCT and the use of artificial intelligence to aid in diagnoses.
Highlights
Diagnostic imaging of the gastrointestinal (GI) tract has long relied on white-light endoscopy (WLE)
Guidance for surveillance of Barrett’s Esophagus (BE) neoplastic progression has been provided by the Seattle Protocol, which advocates for targeted biopsies or resection of suspicious esophageal areas followed by random four-quadrant biopsies at set intervals [59]
In order to eliminate random mucosal biopsies in BE patients, Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) recommends that an imaging technology with targeted biopsies should have a per-patient sensitivity of at least 90% and a negative predictive value (NPV) of at least 98% for detecting high-grade dysplasia (HGD) or early esophageal adenocarcinoma (EAC) [12,63]
Summary
Diagnostic imaging of the gastrointestinal (GI) tract has long relied on white-light endoscopy (WLE). There have been tremendous improvements in the resolution, field of view (FOV), and methods of surface imaging, such as improving contrast in magnification endoscopy and using selected wavelengths (Narrow Band Imaging, NBI) or digital enhancements such as flexible spectral imaging color enhancement (FICE; Fujinon Inc, Saitama, Japan). Subsurface imaging, which includes endoscopic ultrasonography [10], confocal endomicroscopy [11], and OCT, allows for visualization of structures not feasible with most endoscopes Of these technologies, a uniquelyand poised imagingreal-time modality,imaging combining nearly microscopic microscopic resolutionOCT withisvolumetric subsurface capabilities [12]. OCT to incorporate purpose-build probe designs and computer-aided diagnosis techniques [12]
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