Incremental Yield of Dysplasia Detection in Barrettʼs Esophagus Using Volumetric Laser Endomicroscopy With and Without Laser Marking Compared to a Standardized Random Biopsy Protocol

Abstract

Introduction: Volumetric laser endomicroscopy (VLE) is a new wide field advanced imaging technology that can detect microstructure changes of dysplasia in Barrett's esophagus (BE) and target it by placing laser marks in the suspicious areas. Although data exists on safety and efficacy there is no data on the incremental yield of dysplasia detection. Our aim is to report the incremental yield of dysplasia detection in BE using VLE with laser marking. Methods: This is a retrospective study from 2011-2017 comparing the dysplasia yield of four consecutive groups of patients undergoing surveillance in an academic BE tertiary care referral center. The first group received just random biopsies (NSP), the second group Seattle protocol random biopsies (SP+), the third group received surveillance using VLE without laser marking (VLEL-) and the fourth group received VLE with laser marking (VLEL+). Patients with raised lesions or lesions targeted by narrow band imaging were excluded. Use of VLE was based on availability. VLE was available starting 2014 and thus most of the cases in 2014 and almost all in 2015-2017 involved VLE. Results: A total of 386 consecutive patients (53 NSP, 92 SP+, 149 VLEL- and 92 VLEL+) that met inclusion criteria were included in the analysis. The total dysplasia yield was 5.66%, 19.56, 24.82% and 33.69% respectively. When compared to just the SP+ group, VLEL+ had statistically higher rates of dysplasia yield over SP+ (P=0.0306). The total advanced neoplasia yield was 3.77%, 1.09%, 11.4%%, and 14.13% respectively. When compared to just the SP+ and VLE-groups, VLEL+ had statistically higher rates of advanced neoplasia yield (P=0.0009 and 0.0032) respectively. When compared to the control group there was a statistically higher rate of EMR performed of non-raised areas in the VLEL- (6%) and VLEL+ group (15%) (P=0.02 and 0.001). Conclusion: In our cohort VLEL+ lead to statistically significant higher yield of dysplasia detection compared to a standard random biopsy protocol. In addition, VLEL+ may allow for more endoscopic resection of dysplasia due to more precise targeting that may allow pathologists to detect more dysplasia. These results support the use of VLEL+ for surveillance in BE in academic centers but need to be replicated in a prospective study in the community; as tertiary care referral bias can affect the results (eg. patients more like to be surveyed with low-grade dysplasia in a tertiary care setting).FigureTable: No Caption availableTable: Table. Patient and Procedure Characteristics