Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett's esophagus

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

Figures

Fig. 1 a

VLE image of normal squamous mucosa with the layered architecture without glands. Scale bar is 1 mm vertical and horizontal. b Corresponding normal histology.

Fig. 2 a

VLE image showing loss of layered architecture in the setting of no surface pits and crypts. b Atypical glands (yellow arrows) with loss of layered architecture.

Fig. 3

Volumetric laser endomicroscopy images corresponding to the sites that allowed for targeted biopsies. Patient 1 corresponds to A, Patient 2 to B, etc. Features on VLE that allowed targeting of neoplasia included a surface signal intensity > subsurface intensity (patients 1,2,3; red arrow) and atypical glands (Patients 3,4,5,6; yellow arrow). Patients 1,2,3,4, and 6 had loss of layered architecture consistent with intestinal metaplasia. Patient 6 had homogeneous scattering or a washout appearance suggestive of cancer (blue arrow).