Evaluation of NinePoint Medical’s Nvision VLE device for gastrointestinal applications

Abstract

The incidence of esophageal adenocarcinoma (EAC) has increased over the last few decades. With a known precursor lesion, Barrett's esophagus, this remains a target for screening and surveillance with the goal of detecting and providing curative treatment for early neoplasia. Areas covered: Current surveillance techniques rely on white light endoscopy and random tissue sampling which is time consuming, costly and prone to sampling error. Volumetric laser endomicroscopy (VLE), a second-generation optical coherence technology, has emerged as an advanced imaging modality with the potential to improve dysplasia detection, surveillance and subsequently prevent esophageal adenocarcinoma. This review will focus on the use of VLE for advanced imaging of Barrett's esophagus and summarize its current and potential uses elsewhere in the GI tract. Expert commentary: NinePoint's VLE imaging device enables imaging of large segments of BE facilitating identification of luminal and subsurface abnormalities that may have otherwise been missed. Its diagnostic accuracy is improving and laser-marking system adds the capacity for accurate VLE-histologic correlation. With the adoption of dysplasia scoring systems that utilize very few VLE imaging features, inexperienced endoscopists will likely be able to pick out areas concerning for dysplasia to target therapy.

Progress and Challenges of Global High-Resolution Endoscopy

“…VLE, compared to the original OCT system can scan a wider area (6 cm circumferential segment) of the esophagus in real time, to create high resolution (7 um), 3D cross-sectional images while reaching a depth of 3 mm below the mucosa [28]. The Nvision VLE offers a volumetric view of approximately 10.000 mm 2 and has a significantly improved imaging speed and resolution (25 times higher than endoscopic ultrasound) as compared to the first-generation OCT systems [29]. The cross-sectional view of the Nvision VLE can collect approximately 1200 cross-sectional images across the targeted 6 cm, with an option to zoom in for closer examination [29].…”

“…The Nvision VLE offers a volumetric view of approximately 10.000 mm 2 and has a significantly improved imaging speed and resolution (25 times higher than endoscopic ultrasound) as compared to the first-generation OCT systems [29]. The cross-sectional view of the Nvision VLE can collect approximately 1200 cross-sectional images across the targeted 6 cm, with an option to zoom in for closer examination [29].…”

“…Alternatively, the longitudinal view allows the endoscopist to examine the plane of the esophagus perpendicular to its cross-section, with over 4000 longitudinal images of the esophagus [29]. Both these views can be easily manipulated using a touch screen monitor or a hand controller.…”

“…Other recent advancements to this system include the ability to perform laser marking, as well as a more recent "artificial intelligence" system. The Real-Time Targeting TM allows clinicians to make tissue laser marks that are visible under WLE, to facilitate identification and localization of areas for target biopsies [29]. The Intelligent Real-time Image Segmentation TM (IRIS) artificial intelligence software aids image review by segmenting and colorizing the three most common esophageal image features including hyperreflective surface, layering, and hypo-reflective structures in real time [30].…”

Biliary endoscopy in the management of primary sclerosing cholangitis and its complications

“…This technique is similar to EUS in principle but uses lowintensity infrared light (at a wavelength ranging 750–1300 nm) instead of sound, thus allowing for significantly higher resolution images. 116,117 With OCT, visualization of layer architecture (and structures such as blood vessels, lymphoid aggregates, crypts, submucosal glands) is possible at a level of detail approaching that of histopathology. 118-120 Although large studies comparing the accuracy of OCT to other endoscopic modalities are lacking, several small studies have shown that OCT can distinguish benign from malignant lesions with superior accuracy to that of brush cytology.…”