Volumetric Laser Endomicroscopy Enhances the Confirmation of Complete Remission of Intestinal Metaplasia and Dysplasia in Patients Undergoing Barrettʼs Ablation

Abstract

Introduction: Volumetric laser endomicroscopy (VLE) uses next generation optical coherence tomography to provide real-time mucosal imaging to a depth of 3 mm and resolution of 7 microns. We assessed the correlation between white light endoscopy (WLE), with or without adjunctive imaging, and VLE findings and histopathologic confirmation of complete remission of intestinal metaplasia (CR-IM) and dysplasia (CR-D) in patients with previously ablated Barrett's esophagus (BE). Methods: A US-based multicenter registry prospectively collected de-identified demographic, endoscopic, and histologic data from patients undergoing VLE for management of BE using the NvisionVLE™ system (NinePoint Medical, Bedford, MA). This analysis evaluated patients undergoing endoscopic surveillance following prior BE treatment, including endoscopic mucosal resection (EMR), and/or techniques such as radiofrequency ablation (RFA) or cryotherapy (Cryo). Results: 318 procedures from 318 patients were included (mean age 67 years; 80% male) (Table). Adjuncts to WLE were used in 256 procedures. 210 WLE procedures suggested IM via an irregular z-line and/or islands, including 47 with worrisome lesions (eg, nodules). VLE showed areas of concern in 152 (72%) procedures suspicious for IM on WLE and 40 (85%) of the procedures with focal WLE lesions. In the 108 procedures with normal WLE findings, 43 (40%) had suspicious areas seen on VLE and targeted biopsies showed IM in 5 patients (12.5%): NDBE in 4; LGD in 1. Random biopsies in 54 procedures with normal WLE and VLE found IM in 5 patients (9.3%): NDBE in 4; LGD in 1. With normal WLE and VLE, the NPV for IM and dysplasia was 91% and 98%, respectively. Conclusion: VLE identified suspicious lesions for residual or recurrent BE or dysplasia in 40% of postablation cases with normal WLE findings and targeted biopsies showed IM or dysplasia in 14%. Absence of focal abnormalities on both WLE and VLE was a strong predictor of CR-D and CR-IM. Improvements in image interpretation and the ability to target suspicious areas for biopsy will likely lead to enhanced detection of metaplasia in patients thought to have achieved CR-IM or CR-D based on WLE alone. As a strong predictor of both CR-IM and CR-D in patients undergoing BE ablation, VLE may improve current post-treatment surveillance by directing the number and location of biopsies required to correctly detect residual or recurrent disease.Table 1: Patient Demographics