Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett's esophagus
Arvind J Trindade, Benley J George, Joshua Berkowitz, Divyesh V Sejpal, Matthew J McKinley, Arvind J Trindade, Benley J George, Joshua Berkowitz, Divyesh V Sejpal, Matthew J McKinley
Abstract
Methods and study aims: The incidence of esophageal cancer is rising despite increased surveillance efforts. Volumetric laser endomicroscopy (VLE) is a new endoscopic imaging tool that can allow for targeted biopsy of neoplasia in Barrett's esophagus. We report a series of 6 patients with long-segment Barrett's esophagus ( > 3 cm), who underwent a session of endoscopy with volumetric laser endomicroscopy, after a separate prior session of standard high-definition endoscopy with narrow band imaging (NBI) and random biopsies that did not reveal neoplasia. In all six patients, the first endoscopy was the index endoscopy diagnosing the Barrett's esophagus. All VLE exams were performed within 6 months of the previous endoscopy. In five patients, VLE-targeted biopsy resulted in upstaged disease/diagnosed dysplasia that then qualified the patient for endoscopic ablation therapy. In one patient, VLE localized a focus of intramucosal cancer that allowed for curative endoscopic mucosal resection. This case series shows that endoscopy with VLE can target neoplasia that cannot be localized by high-definition endoscopy with NBI and random biopsies.
Conflict of interest statement
Competing interests: None
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References
- Sharma P, Brill J, Canto M. et al.Advanced Imaging in Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2015
- Sauk J, Coron E, Kava L. et al.Interobserver agreement for the detection of Barrett’s esophagus with optical frequency domain imaging. Dig Dis Sci. 2013;58:2261–2265.
- Evans J A, Poneros J M, Bouma B E. et al.Optical coherence tomography to identify intramucosal carcinoma and high-grade dysplasia in Barrett’s esophagus. Clin Gastroenterol Hepatol. 2006;4:38–43.
- Leggett C L, Gorospe E, Owens V L. Nature Publishing Group et al.Volumetric laser endomicroscopy detects subsquamous Barrett’s adenocarcinoma. Am J Gastroenterol. 2014; 109:298–299.
- Wang K K, Sampliner R E. Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett’s Esophagus. Am J Gastroenterol. 2008;103:788–797.
- Poneros J M, Brand S, Bouma B E. et al.Diagnosis of specialized intestinal metaplasia by optical coherence tomography. Gastroenterology. 2001;120:7–12.
- Leggett C L, Gorospe E C, Chan D K. et al.Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett’s esophagus. Gastrointest Endosc. 2015
- Wolfsen H C, Sharma P, Wallace M B. et al.Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos) Gastrointest Endosc. 2015;3:1–10.
- Swager A-F, Boerwinkel D F, de Bruin D M. et al.Detection of buried Barrett’s glands after radiofrequency ablation with volumetric laser endomicroscopy. Gastrointest Endosc. 2015:1–9.
- Trindade A J, Vamadevan A S, Sejpal D V. Finding a needle in a haystack: use of volumetric laser endomicroscopy in targeting focal dysplasia in long-segment Barrett’s esophagus. Gastrointest Endosc. 2015;82:756–757.
Source: PubMed