Mo1256 EPITHELIAL GLAND BURDEN DETERMINED BY VOLUMETRIC LASER ENDOMICROSCOPY IS ASSOCIATED WITH COMPLETE REMISSION OF INTESTINAL METAPLASIA FOLLOWING ENDOSCOPIC ERADICATION THERAPY FOR BARRETT’S ESOPHAGUS

Abstract

Endoscopic eradication of Barrett’s esophagus (BE) aims to achieve complete remission of intestinal metaplasia (CRIM), defined by absence of visible columnar mucosa on high-definition white light (HDWL) endoscopy and negative biopsies for intestinal metaplasia (IM). Given sampling error associated with random biopsies, some experts recommend two consecutive negative endoscopies to establish CRIM. Volumetric laser endomicroscopy (VLE) is an advanced imaging modality capable of comprehensive high-resolution imaging of BE. Epithelial glands are a VLE feature associated with BE. We hypothesize that VLE epithelial gland burden in the gastroesophageal junction (GEJ) is associated with the presence of IM in patients with BE following endoscopic eradication therapy. Patients with BE with absence of visible columnar mucosa on HDWL endoscopy following endoscopic eradication therapy underwent VLE imaging. Random surveillance biopsies were obtained as per standard protocol. VLE scans were analyzed with intelligent real-time image segmentation (IRIS), an artificial intelligence software that superimposes features of interest (signal intensity, mucosal layering, epithelial glands) onto an en-face map of the esophagus. The GEJ on IRIS en-face scans was defined as the transition between squamous epithelium (presence of layering, normal signal intensity) and cardia (lack of layering, increased signal intensity) and demarcated using image processing software ImageJ. We previously showed that the surface area occupied by epithelial glands correlates with manual gland quantification. The GEJ demarcation was transferred to an en-face map of epithelial glands and the surface area (gland burden) was measured 1 cm proximal and 1 cm distal to the GEJ for each VLE scan (Figure 1) The mean gland surface area of VLE scans from patients with IM negative biopsies was compared to those with IM positive biopsies using the Student t-test. This study was funded by the ASGE Endoscopy Research Award. A total of 123 BE patients without visible BE on HDWL endoscopy following endoscopic therapy underwent VLE. Random biopsies were negative for IM in 87 and positive in 36 patients. Highest grade of histology was non-dysplastic BE (N=32), indefinite (N=2), low-grade (N=2). The mean (SD) gland surface area in the GEJ was significantly higher in patients with IM positive biopsies compared to patients with IM negative biopsies [10.1(9.9)mm2 vs. 6.5(5.5)mm2, p=0.02] (Figure 2) Systematic quantification of epithelial gland burden in the GEJ using VLE can predict presence of IM in patients with BE following endoscopic eradication therapy. VLE may have a role in confirming true CRIM and reducing number of required surveillance endoscopies.Mean gland surface area measured in patients with absence of visible columnar mucosa on high-definition white light endoscopy and negative surveillance biopsies for IM (group 0) and positive surveillance biopsies for IM (group 1)View Large Image Figure ViewerDownload Hi-res image Download (PPT)