Mo1263 CLOCK-FACE DISTRIBUTION OF VISIBLE VS INVISIBLE DYSPLASIA IN BARRETT’S ESOPHAGUS: A POOLED ANALYSIS OF THREE PROSPECTIVE STUDIES

Abstract

Studies have suggested that dysplasia in Barrett’s Esophagus (BE) has a predilection for the right hemisphere of the esophagus in patients who are ablation naive. However, these studies were limited by only including dysplasia detected in visible lesions on high-definition white light endoscopy (HDWLE). Advanced imaging such as volumetric laser endomicroscopy (VLE) allows for visualization of lesions that cannot always be detected on HDWLE and for precise targeting/lesion location with laser marking. Thus, the aim of this study was to further describe the circumferential distribution of dysplasia found in visible lesions on HDWLE and invisible lesions (detected only by VLE) in a prospective fashion. This is an analysis of patients treated at one tertiary care center from three separate prospective studies (VLE IRIS Study NCT03814824, VLE Dysplasia Detection Pilot NCT02864043, and the VLE National Registry NCT02215291) who underwent evaluation for BE with HDWLE and VLE with laser marking (for the first two mentioned studies) between 9/2016 and 10/2019. Only visible lesions were recorded from patients for the national registry study, as laser marking was not available during this study. Patients were included if they were over the age of 18 with confirmed dysplasia on biopsy. The location of lesions was recorded prospectively with the gastroscope in the neutral position. Orientation of VLE laser marked targeted lesions were recorded based on the endoscope in the neutral position. Quadrant 1 was defined as 12-3 o’clock, quadrant 2 was 3-6 o’clock, quadrant 3 was 6-9 o’clock, and quadrant 4 was 9-12 o’clock. Visible versus invisible lesion characteristics were compared. Data was prospectively collected on 149 dysplastic lesions in 102 patients. 35.6% of the lesions were IMCA, 38.8% were HGD, and 25.5% were LGD on surgical pathology. There was an approximately equal distribution of each type of dysplastic lesion within each the 4 quadrants and between the left and right hemispheres. 73.8% of the lesions were visible on HDWLE; the rest were discovered only by VLE examination. The majority of visible lesions were IMCA (43.6%), whereas the majority of invisible lesions were LGD (46.2%). There was no significant difference in the distribution of visible and invisible lesions within the 4 quadrants or hemispheres, and furthermore, when stratified by class of dysplasia, the distribution again remained relatively uniform. In contrast to previously retrospective published data on clock-face orientation showing dysplasia predilection in the right hemisphere, we found no difference in the clock-face distribution of dysplasia when examined with HDWLE and advanced imaging in a prospective fashion. Dysplasia can be found throughout the whole clock-face and thus a careful, 360-degree evaluation is necessary.Table 1Details of clock-face orientation of dysplasia for the pooled analysis of three prospective studies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)