Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry

Abstract

SUMMARYVolumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291

Volumetric Laser Endomicroscopy in Barrett's Esophagus

“…However, while there was an increase in neoplasia detection, there was also a large proportion of VLE-guided biopsies taken without a finding of dysplasia on histology. Limitations to this study include lack of a defined protocol for imaging and image interpretation as well as potential overcalling areas of a concern during early experience of the users 36 .…”

“…Identifying lesions during VLE not seen on white light endoscopy could potentially lead to upstaging of neoplasia or a change in management. A questionnaire surveying endoscopists participating in a VLE patient registry reported that VLE was used to guide endoscopic therapy in 52% of cases, and that in 40% of procedures, the depth or extent of disease identified on VLE influenced the choice of treatment modality 36 .…”

“…Radiofrequency ablation is able to achieve complete eradication of IM in the majority of patients with recurrence of BE in approximately 20% of patients 40 . In posttreatment patients, VLE can detect lesions that may otherwise be missed under white light examination of the tubular esophagus and gastric cardia 7,36 . The ability to detect subsurface structures may also be beneficial in this setting for detection of subsquamous BE.…”

Transfer learning from simulations improves the classification of OCT images of glandular epithelia

“…We focus on BE as the first structural transition along the EAC pathway, where the stratified epithelium of the healthy esophagus is replaced with a glandular epithelium that mimics the gastric and intestinal morphologies. Microscopic examination of this lesion reveals a complete restructuring of the affected tissue into a glandular mucosa, resulting in a loss of clear lamination between the epithelium and the stroma, which is reflected in the OCT signal [5].…”

“…dysplasia) remain difficult to detect with existing practices, and a balance between diagnostic yield, cost-effectiveness, and intrusiveness of screening is yet to be reached. Advanced imaging modalities like optical coherence tomography (OCT) are emerging technologies that may improve the accuracy and reduce the intrusiveness of the standard of care in endoscopic EAC surveillance [4], [5]. Subsurface tissue imaging with OCT provides rich depth-resolved structural information on the entire distal esophagus.…”