BACKGROUND: Dysplastic Barrett's esophagus (BE) lesions ≤2 cm in size can be targeted for en-bloc endoscopic mucosal resection (EMR). White-light endoscopy can underestimate the size of a lesion, limiting complete resection. Volumetric laser endomicroscopy (VLE) provides high-resolution cross-sectional imaging of BE. Epithelial glands are a VLE feature associated with BE dysplasia. We study the association between VLE gland quantification and outcome of resection. METHODS: EMR specimens of BE lesions targeted for en-bloc resection were imaged with VLE using an established protocol. Manual and automated quantification of epithelial glands was performed blinded to resection outcome. The presence of epithelial glands at the resection margins was recorded. Histologic en-bloc (R0) resection of the targeted lesion was defined by the absence and incomplete (R1) resection by the presence of dysplasia/neoplasia at specimen margins. RESULTS: Thirty-seven EMRs with a mean (standard deviation) size of 1.04 (0.37) cm were imaged with VLE. The highest grade of dysplasia found was low-grade dysplasia (n = 12), high-grade dysplasia (n = 19), and intramucosal cancer (n = 6). The en-bloc resection rate was 37.8% (R0, n = 14; R1, n = 23). The mean (standard deviation) number of epithelial glands quantified with VLE was 13.0 (6.7) and 28.8 (23.9) for R0 and R1 specimens, respectively, with a significant mean difference of 15.8 glands (95% confidence interval, 2-29; P = .02). The presence of glands at the specimen margin was associated with incomplete resection (P < .001). CONCLUSION: Systematic quantification of BE epithelial glands using VLE can determine the outcome of endoscopic resection. VLE may have a potential role in assessment of lesion margins.
BACKGROUND:Dysplastic Barrett's esophagus (BE) lesions ≤2 cm in size can be targeted for en-bloc endoscopic mucosal resection (EMR). White-light endoscopy can underestimate the size of a lesion, limiting complete resection. Volumetric laser endomicroscopy (VLE) provides high-resolution cross-sectional imaging of BE. Epithelial glands are a VLE feature associated with BE dysplasia. We study the association between VLE gland quantification and outcome of resection. METHODS: EMR specimens of BE lesions targeted for en-bloc resection were imaged with VLE using an established protocol. Manual and automated quantification of epithelial glands was performed blinded to resection outcome. The presence of epithelial glands at the resection margins was recorded. Histologic en-bloc (R0) resection of the targeted lesion was defined by the absence and incomplete (R1) resection by the presence of dysplasia/neoplasia at specimen margins. RESULTS: Thirty-seven EMRs with a mean (standard deviation) size of 1.04 (0.37) cm were imaged with VLE. The highest grade of dysplasia found was low-grade dysplasia (n = 12), high-grade dysplasia (n = 19), and intramucosal cancer (n = 6). The en-bloc resection rate was 37.8% (R0, n = 14; R1, n = 23). The mean (standard deviation) number of epithelial glands quantified with VLE was 13.0 (6.7) and 28.8 (23.9) for R0 and R1 specimens, respectively, with a significant mean difference of 15.8 glands (95% confidence interval, 2-29; P = .02). The presence of glands at the specimen margin was associated with incomplete resection (P < .001). CONCLUSION: Systematic quantification of BE epithelial glands using VLE can determine the outcome of endoscopic resection. VLE may have a potential role in assessment of lesion margins.
Authors: Prateek Sharma; Kenneth McQuaid; John Dent; M Brian Fennerty; Richard Sampliner; Stuart Spechler; Alan Cameron; Douglas Corley; Gary Falk; John Goldblum; John Hunter; Janusz Jankowski; Lars Lundell; Brian Reid; Nicholas J Shaheen; Amnon Sonnenberg; Kenneth Wang; Wilfred Weinstein Journal: Gastroenterology Date: 2004-07 Impact factor: 22.682
Authors: Anne-Fré Swager; David F Boerwinkel; Daniel M de Bruin; Dirk J Faber; Ton G van Leeuwen; Bas L Weusten; Sybren L Meijer; Jacques J Bergman; Wouter L Curvers Journal: Gastrointest Endosc Date: 2015-06-26 Impact factor: 9.427
Authors: Anne-Fré Swager; Guillermo J Tearney; Cadman L Leggett; Martijn G H van Oijen; Sybren L Meijer; Bas L Weusten; Wouter L Curvers; Jacques J G H M Bergman Journal: Gastrointest Endosc Date: 2016-09-19 Impact factor: 9.427
Authors: O Pech; A Behrens; A May; L Nachbar; L Gossner; T Rabenstein; H Manner; E Guenter; J Huijsmans; M Vieth; M Stolte; C Ell Journal: Gut Date: 2008-05-06 Impact factor: 23.059
Authors: Cadman L Leggett; Emmanuel C Gorospe; Daniel K Chan; Prasuna Muppa; Victoria Owens; Thomas C Smyrk; Marlys Anderson; Lori S Lutzke; Guillermo Tearney; Kenneth K Wang Journal: Gastrointest Endosc Date: 2015-09-03 Impact factor: 9.427