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Sa1111 Potential Role of Volumetric Laser Endomicroscopy in Surveillance in Patients With Barrett's Esophagus After Therapy
AGA Abstracts Image 1. Patient with metastatic teratoma following left pneumonectomy, thoracoplasty, esophageal diversion and aortic bypass (esophagus in black)
Image 2. Patient with multiple esophageal diverticulae, 3D printed anatomic model to allow visualisation of the relationships of the esophagus (esophagus in black)
Sa1111 Potential Role of Volumetric Laser Endomicroscopy in Surveillance in Patients With Barrett's Esophagus After Therapy Baldeep Pabla, Irving Waxman, Ann Koons, Mariano Gonzalez-Haba Ruiz, Uzma D. Siddiqui, Andres Gelrud, Shu-Yuan Xiao, John Hart, Vani J. Konda Background: During and after treatment in Barrett's esophagus (BE), volumetric Laser Endomicroscopy (VLE), based on optical coherence tomography may have potential to detect occult or buried disease. This is a pilot study to determine the clinical role and the image characteristics in VLE post therapy in a center with a referral practice for BE. Methods: Patients with BE presented for treatment or surveillance post therapy. Endoscopy was performed with high resolution white light endoscopy (WLE), narrow band imaging (NBI) with and without near focus, and VLE. Tissue acquisition with either endoscopic mucosal resection or biopsy forceps was performed based on endoscopists' discretion. VLE images were obtained and correlated with histology and prior treatment. A subset of patients with radical EMR and circumferential RFA were selected for image analysis. The range of epithelial thickness was measured using Image J software every 1 cm where esophageal tissue was noted. Representative images of the number of submucosal glands (SMG) and ducts present on each scan were obtained and the number of glands present were individually counted in these images with focus on previously treated areas. Those patients who had no prior therapy or underwent diagnostic focal EMR only were excluded. Results: Twenty patients who had previously undergone EMR or RFA for the treatment of BE underwent VLE imaging with an average age of 65.3 y and initial BE segment length average of 6.6 +/- 4.0 cm. Initial highest pre-treatment pathology was adenocarcinoma in 3 cases, high grade dysplasia (HGD) in 10, low grade dysplasia (LGD) in 5, and non-dysplastic BE in 2. Five patients previously underwent radical EMR, 11 hybrid therapy, 4 RFA alone. At the time of VLE imaging, 7 patients were noted to have residual BE by WLE. In one case with residual BE noted on WLE, VLE targeted EMR demonstrated HGD. In two patients in surveillance, VLE detected buried glands which appeared to have corresponding discoloration noted by NBI. One case was confirmed as buried BE on pathology, and the other case had non-goblet columnar lined glands in the tubular esophagus. Those patients that had RFA were more likely to have an increase in SMG proliferation (13.5 versus 3 glands/per patient, p<0.05). In regards to epithelial thickness, there was no significant difference note between the radial EMR treated patients versus the post RFA patients. Conclusion: VLE has the potential to detect occult disease and buried glands in the post treatment setting of Barrett's esophagus. SMG proliferation was increased in those patients who underwent previous RFA. Further studies are needed to determine the clinical significance of SMG proliferation.
AGA Abstracts
S-228
Image 2. Patient with multiple esophageal diverticulae, 3D printed anatomic model to allow visualisation of the relationships of the esophagus (esophagus in black)
Sa1111 Potential Role of Volumetric Laser Endomicroscopy in Surveillance in Patients With Barrett's Esophagus After Therapy Baldeep Pabla, Irving Waxman, Ann Koons, Mariano Gonzalez-Haba Ruiz, Uzma D. Siddiqui, Andres Gelrud, Shu-Yuan Xiao, John Hart, Vani J. Konda Background: During and after treatment in Barrett's esophagus (BE), volumetric Laser Endomicroscopy (VLE), based on optical coherence tomography may have potential to detect occult or buried disease. This is a pilot study to determine the clinical role and the image characteristics in VLE post therapy in a center with a referral practice for BE. Methods: Patients with BE presented for treatment or surveillance post therapy. Endoscopy was performed with high resolution white light endoscopy (WLE), narrow band imaging (NBI) with and without near focus, and VLE. Tissue acquisition with either endoscopic mucosal resection or biopsy forceps was performed based on endoscopists' discretion. VLE images were obtained and correlated with histology and prior treatment. A subset of patients with radical EMR and circumferential RFA were selected for image analysis. The range of epithelial thickness was measured using Image J software every 1 cm where esophageal tissue was noted. Representative images of the number of submucosal glands (SMG) and ducts present on each scan were obtained and the number of glands present were individually counted in these images with focus on previously treated areas. Those patients who had no prior therapy or underwent diagnostic focal EMR only were excluded. Results: Twenty patients who had previously undergone EMR or RFA for the treatment of BE underwent VLE imaging with an average age of 65.3 y and initial BE segment length average of 6.6 +/- 4.0 cm. Initial highest pre-treatment pathology was adenocarcinoma in 3 cases, high grade dysplasia (HGD) in 10, low grade dysplasia (LGD) in 5, and non-dysplastic BE in 2. Five patients previously underwent radical EMR, 11 hybrid therapy, 4 RFA alone. At the time of VLE imaging, 7 patients were noted to have residual BE by WLE. In one case with residual BE noted on WLE, VLE targeted EMR demonstrated HGD. In two patients in surveillance, VLE detected buried glands which appeared to have corresponding discoloration noted by NBI. One case was confirmed as buried BE on pathology, and the other case had non-goblet columnar lined glands in the tubular esophagus. Those patients that had RFA were more likely to have an increase in SMG proliferation (13.5 versus 3 glands/per patient, p<0.05). In regards to epithelial thickness, there was no significant difference note between the radial EMR treated patients versus the post RFA patients. Conclusion: VLE has the potential to detect occult disease and buried glands in the post treatment setting of Barrett's esophagus. SMG proliferation was increased in those patients who underwent previous RFA. Further studies are needed to determine the clinical significance of SMG proliferation.
AGA Abstracts
S-228