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.

Volumetric Laser Endomicroscopy for Barrett’s Esophagus – Looking at the Fine Print

“…The NvisionVLETM system was used in all studies [23][24][25][26][27][28][29]. Volumetric laser endomicroscopy is a second-generation optical coherence tomography.…”

“…Long segment imaging can be obtained with an axial resolution of 7 µm, a transverse resolution of about 30 µm, and can reach an imaging depth of up to 2 to 3 mm. A total of 1200 images can be obtained in 96 secs [23][24][25][26].…”

“…There were 33 cases of BE, 4 cases of low-grade dysplasia (LGD), 13 cases of high-grade dysplasia (HGD) and 12 cases of intramucosal adenocarcinoma (IMC) [23][24][25][26][27][28][29]. The indication for endoscopy was surveillance for IMC or dysplasia among patients with BE or for surveillance of buried Barrett's (BB) among post ablation subjects, except two cases where the indication was therapeutic for LGD and IMC [26].…”

“…In 7 cases, no previous treatment was performed [25,26]. Twenty-eight patients had no information available about prior treatment [23,29], while the rest of patients had received either RFA, EMR or dilation of esophageal stricture [24][25][26][27].…”

Computer-aided detection of early Barrett’s neoplasia using volumetric laser endomicroscopy

“…8,9 In vivo case reports suggested that VLE could detect additional neoplasia, however, clinical trials in larger sample size are necessary to confirm these findings. 10 We envision that development of quantitative methods that enable red-flagging of areas suspicious for neoplasia, is important to aid endoscopists in real-time interpretation of VLE scans. In this study we examine such a quantitative method focusing on computer-aided detection.…”