Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study

Abstract

ObjectiveVolumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there are in vivo VLE features that can predict gastric cardia dysplasia in BE.DesignThis was a single-centre observational cohort study from August 2016 to August 2018. Patients were included if they had BE, were undergoing a VLE exam as standard of care, and had a suspicious target laser marked at the gastric cardia. The following VLE features were correlated to histology to determine if an association existed between histology subtype and VLE feature: wide crypts, irregular surface, one large isolated gland, multiple glands, and complex glands.ResultsA total of 110 in vivo gastric cardia targets in 77 patients with BE were analysed. The following abnormalities were identified: 61 wide crypts, 34 isolated glands, 16 irregular surfaces, 15 multiple glands, and 11 complex glands. Complex glands were the only VLE feature that correlated to any histology subtype. They were present in 71% of targets with high-grade dysplasia (HGD), T1a cancer or T1b cancer and had a sensitivity, specificity, and accuracy of 71%, 99%, and 85%, respectively. Of the 10 patients with complex glands on VLE and HGD/cancer on histology, 4 had a normal-appearing mucosa (40%) on endoscopy.ConclusionIdentification of complex glands on VLE may aid in detection of HGD or early cancer in the gastric cardia in BE. This is particularly important, as dysplasia at the gastric cardia can be difficult to see endoscopically.

Developing patient-orientated Barrett’s oesophagus services: the role of dedicated services

“…Advanced imaging techniques are a vital part of lesion recognition (eg, NBI, I-scan and volumetric laser endomicroscopy), enhancing abnormal vasculature and mucosal surface patterns, with many hoping targeted biopsies could replace Seattle protocol biopsies. [34][35][36] Dilute acetic acid dye spray which causes a reversible reaction to the BO epithelium with early reversal in dysplastic tissues can be used to help detect dysplasia. It has been found to be cost effective if resulting in targeted samples alone in the surveillance population -particularly in higher risk groups.…”

Volumetric Laser Endomicroscopy in Barrett's Esophagus

“…Trindade et al evaluated 110 gastric cardia targets in 77 BE patients and found that complex glands on VLE correlated with HGD or early cancer of the gastric cardia with high specificity. Of the patients with complex glands on VLE and neoplasia on histology, 40% had normal appearing mucosa on endoscopic examination 22 .…”

Advanced endoscopic imaging for detecting and guiding therapy of early neoplasias of the esophagus

“…85 While the neoplastic implications of glands buried under subsequent neosquamous epithelium remain unclear, 86 such structures are prevalent near the gastroesophageal junction and gastric cardia after ablation, 84 and may help identify neoplasias. 87 While conventional balloon-based OCT catheters may not adequately image the cardia, forwardviewing probes that can be retroflexed during endoscopy hold promise. 88 Another advance that has become available through faster acquisition and processing is the ability to enhance images by analyzing Doppler-like frame-to-frame changes created by coursing red blood cells to define microangiopathic changes, 89 which with further improvements 90 appear to correlate with early dysplastic changes.…”

“…OCT also has a role in postablative imaging and can reveal residual BE glands 84 that are predictive of postablative outcomes for achieving complete eradication of all intestinal metaplasias 85 . While the neoplastic implications of glands buried under subsequent neosquamous epithelium remain unclear, 86 such structures are prevalent near the gastroesophageal junction and gastric cardia after ablation, 84 and may help identify neoplasias 87 . While conventional balloon‐based OCT catheters may not adequately image the cardia, forward‐viewing probes that can be retroflexed during endoscopy hold promise 88 .…”