Volumetric laser endomicroscopy can target neoplasia not detected by conventional endoscopic measures in long segment Barrett’s esophagus

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.

• References

• 1 Sharma P, Brill J, Canto M et al. Advanced Imaging in Barrett’s Esophagus. Clin Gastroenterol Hepatol 2015;
• 2 Sauk J, Coron E, Kava L et al. Interobserver agreement for the detection of Barrett’s esophagus with optical frequency domain imaging. Dig Dis Sci 2013; 58: 2261-2265
• 3 Evans JA, Poneros JM, Bouma BE et al. Optical coherence tomography to identify intramucosal carcinoma and high-grade dysplasia in Barrett’s esophagus. Clin Gastroenterol Hepatol 2006; 4: 38-43
• 4 Leggett CL, Gorospe E, Owens VL. Nature Publishing Group et al. Volumetric laser endomicroscopy detects subsquamous Barrett’s adenocarcinoma. Am J Gastroenterol 2014; 109: 298-299
• 5 Wang KK, Sampliner RE. Updated Guidelines 2008 for the Diagnosis, Surveillance and Therapy of Barrett’s Esophagus. Am J Gastroenterol 2008; 103: 788-797
• 6 Poneros JM, Brand S, Bouma BE et al. Diagnosis of specialized intestinal metaplasia by optical coherence tomography. Gastroenterology 2001; 120: 7-12
• 7 Leggett CL, Gorospe EC, Chan DK et al. Comparative diagnostic performance of volumetric laser endomicroscopy and confocal laser endomicroscopy in the detection of dysplasia associated with Barrett’s esophagus. Gastrointest Endosc 2015;
• 8 Wolfsen HC, Sharma P, Wallace MB et al. Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos). Gastrointest Endosc 2015; 3: 1-10
• 9 Swager A-F, Boerwinkel DF, de Bruin DM et al. Detection of buried Barrett’s glands after radiofrequency ablation with volumetric laser endomicroscopy. Gastrointest Endosc 2015; 1-9
• 10 Trindade AJ, Vamadevan AS, Sejpal DV. Finding a needle in a haystack: use of volumetric laser endomicroscopy in targeting focal dysplasia in long-segment Barrett’s esophagus. Gastrointest Endosc 2015; 82: 756-757