Abstract
Two main nonsurgical endoscopic approaches for ablating dysplastic and early cancer lesions in the esophagus have gained popularity, namely, radiofrequency ablation (RFA) and cryospray ablation (CSA). We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after RFA and CSA. The maximum depths of architectural changes were measured and compared between the two treatment groups. RFA was observed to induce 230~260 μm depth of architectural changes after each set of ablations over a particular region, while CSA was observed to induce edema-like spongiform changes to ~640 μm depth within the ablated field. The ability to obtain micron-scale depth-resolved images of tissue structural changes following different ablation therapies makes 3D-OCT an ideal tool to assess treatment efficacy. Such information could be potentially used to provide real-time feedback for treatment dosing and to identify regions that need further retreatment.
Highlights
Radiofrequency ablation (RFA) and cryospray ablation (CSA) are recently developed methods that utilize thermal gradients to treat dysplastic and early cancer lesions of the esophagus, such as those arising in the setting of Barrett’s esophagus (BE)
We report a uniquely suited endoscopic and near-microscopic imaging modality, three-dimensional (3D) optical coherence tomography (OCT), to assess and compare the esophagus immediately after radiofrequency ablation (RFA) and CSA
3D-OCT imaging was performed on patients following RFA (n = 10) and CSA (n = 3) treatments for BE with the BARRX Halo90 system and the CSA Medical system, respectively
Summary
Radiofrequency ablation (RFA) and cryospray ablation (CSA) are recently developed methods that utilize thermal gradients to treat dysplastic and early cancer lesions of the esophagus, such as those arising in the setting of Barrett’s esophagus (BE). Both therapeutic technologies allow broad and superficial treatment fields for BE [1,2,3,4,5,6,7,8]. Recent clinical trials using RFA treatment have shown that complete eradication of dysplasia (CE-D) was achieved in 98% and 93% of patients with low-grade dysplasia (LGD) and highgrade dysplasia (HGD) at two-year followup [9]. Another multicenter study reported 97%, 87%, and 57% complete eradication of HGD, CE-D, and CE-IM at 10.5 months of followup [7]
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