High Resolution Wide-Field Esophageal Microscopy for the Surveillance of Barrettʼs Dysplasia After Endoscopic Ablation Presidential Poster

Abstract

Purpose: Optical coherence tomography (OCT) is an endomicroscopy technology that has been used to detect dysplasia in Barrett's esophagus (BE). OCT is limited by its narrow-field of view and slow image acquisition. A novel imaging modality, volumetric laser endomicroscopy (VLE), uses a balloon catheter with a second-generation OCT, termed optical frequency-domain imaging, to generate volumetric images of the esophageal mucosa at 10 μm resolution. We present a case series of 9 patients who underwent VLE imaging for the detection of dysplasia after endoscopic treatment. Methods: Nine patients underwent clinically-indicated endoscopy with VLE. VLE images were acquired from 6 cm long segments of the esophagus with an image acquisition time of 96 seconds. After imaging, 4-quadrant surveillance biopsies were acquired. Expert pathology review of the biopsies was performed at our tertiary referral center by 2 pathologists who were blinded to the VLE results. Histology-like VLE images at the gastroesophageal junction (GEJ) and distal esophagus were interpreted by an independent pathologist with VLE experience, blinded to the histology results. VLE interpretation was accomplished using previously published OCT features of dysplasia based on poor surface maturation and abnormal gland architecture. VLE diagnoses of dysplasia were compared to the histopathologic diagnoses of the biopsies on a per patient basis. Results: All 9 patients had a history of biopsy-proven BE-high grade dysplasia (HGD) with prior endoscopic mucosal resection and ablation. There were 8 males. Their median age was 69 y/o (range 43-79). Four patients had persistent HGD at the GEJ on histology. VLE was read as HGD for all four patients with biopsy-confirmed HGD in this cohort and VLE interpretation suggested the presence of HGD in 3 cases where dysplasia was not found on biopsy. VLE also identified a case with image features consistent with buried intestinal metaplasia that was not detected by biopsies. No adverse events were reported in all 9 cases. Figure 1 shows a representative cross sectional VLE image of the distal esophagus.Figure 1: No Caption available.Conclusion: VLE may be an effective imaging modality in patients with BE dysplasia who are undergoing surveillance after endoscopic ablation. Its high resolution and wide-field imaging can potentially detect dysplasia that is missed with the standard biopsy protocol. Disclosure: Dr. Wang - Consultancy and research support from Covidien, NinePoint Medical, CDX Diagnostic, Fujinon and Pinnacle. Dr. Tearney-Consultancy and research support from NinePoint Medical and Samsung. Ms. Lutzke- Research support from Covidien, NinePoint Medical and Fujinon. All rest of authors have no financial disclosures.