Value of endomicroscopy in the assessment of tumor extension prior to endoscopic resection of Barrett's esophagus-associated neoplasia: A pilot study

Background and Study Aims: Barrett's esophagus (BE)-associated neoplasia can be treated by endoscopy, but accurate preinterventional assessment is challenging. This study aimed to investigate the value of confocal laser endomicroscopy (CLE) as an adjunct in the endoscopic treatment of BE-associated neoplasia by assessing lateral and subsquamous tumor extension (SSTE).

Patients and Methods: In the context of a prospective single arm clinical pilot trial patients referred for endoscopic resection of BE-associated neoplasia (high grade dysplasia and esophageal adenocarcinoma) underwent high definition white light endoscopy with narrow band imaging (NBI), followed by CLE-mapping of suspected neoplastic lesions (performed by another endoscopist partially blinded to the previous findings) prior to endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) depending on lesion size and anticipated histology.

Results: In 7/38 (18%) patients CLE revealed additional neoplastic tissue as compared to prior white light and NBI – two concomitant lesions, two cases of lateral tumor extension within the Barrett's epithelium and three cases of previously undetected SSTE. Overall, en-bloc resection (tumor-free lateral margin) was achieved in 28/34 neoplastic lesions (82%) and complete resection (tumor-free lateral and basal margins) in 21/34 neoplastic lesions (62%).

Conclusions: CLE-assisted endoscopic resection of BE-associated neoplasia was safe and effective in this study, proved by a high additional diagnostic yield of CLE (including visualization of occult SSTE) and a favorable en-bloc resection rate. The clinical value of CLE for assisting endoscopic therapy of BE-associated neoplasia deserves further evaluation in a randomized controlled study.