Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barrett’s esophagus neoplasia

Jayasekera, Chatura; Taylor, Andrew; Desmond, Paul; Macrae, Finlay; Williams, Richard A.

doi:10.1055/s-0032-1325734

Cited by 54 publications

(43 citation statements)

References 16 publications

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“…Without NBI, pCLE may have suboptimal sensitivity (12%) and PPV (18%) when used as a technique to potentially replace RB 28 . A recent non-randomized study reported a lower sensitivity of eCLE (75.7% without considering prior NBI) compared to HDWLE+NBI (89%) 29 . However, this 46 patient pilot study underpowered and the sensitivity of eCLE was low compared to other studies 13,30 .…”

Section: Discussionmentioning

confidence: 94%

In vivo endomicroscopy improves detection of Barrett's esophagus–related neoplasia: a multicenter international randomized controlled trial (with video)

Canto

Anandasabapathy

Brugge

et al. 2014

Gastrointestinal Endoscopy

177

127

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BACKGROUND Confocal laser endomicroscopy (CLE) enables in vivo microscopic imaging of the gastrointestinal tract mucosa. However, there are limited data on endoscope-based eCLE for imaging Barrett’s esophagus (BE). OBJECTIVE To compare high definition white light endoscopy alone (HDWLE) with random biopsy (RB) and HDWLE+eCLE and targeted biopsy (TB) for diagnosis of BE neoplasia. DESIGN Multicenter randomized controlled trial. SETTING Academic medical centers. PATIENTS Adult BE patients undergoing routine surveillance or referred for early neoplasia. INTERVENTIONS Patients were randomized to HDWLE+RB (Group 1) or HDWLE+eCLE+TB (Group 2). Real time diagnoses and management plans were recorded after HDWLE in both groups, and after eCLE in Group 2. Blinded expert pathologic diagnosis was the reference standard. MAIN OUTCOME MEASUREMENTS Diagnostic yield, performance characteristics, clinical impact. RESULTS 192 BE patients were studied. HDWLE+eCLE+TB led to a lower number of mucosal biopsies, higher diagnostic yield for neoplasia (34% vs. 7%, p<.0001) compared to HDWLE+RB but with comparable accuracy. HDWLE+eCLE+TB tripled the diagnostic yield for neoplasia (22% vs. 6%, p=.002) and would have obviated the need for any biopsy in 65% of patients. The addition of eCLE to HDWLE increased the sensitivity for neoplasia detection to 96% from 40% (p<.0001) without significant reduction in specificity. In vivo CLE changed the treatment plan in 36% of patients. LIMITATIONS Tertiary referral centers and expert endoscopists limiting generalizability. CONCLUSIONS Real time eCLE and targeted biopsy after HDWLE can improve the diagnostic yield and accuracy for neoplasia and significantly impact in vivo decision-making by altering the diagnosis and guiding therapy.

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Section: Discussionmentioning

confidence: 94%

In vivo endomicroscopy improves detection of Barrett's esophagus–related neoplasia: a multicenter international randomized controlled trial (with video)

Canto

Anandasabapathy

Brugge

et al. 2014

Gastrointestinal Endoscopy

177

127

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“…Although other emerging endoscopic imaging techniques have been proposed for this purpose or have even been shown to improve biopsy yield, 18,19 the advantage of VLE-guided biopsy is that the distal 6 cm of the esophagus is scanned in 3 dimensions at the microscopic level. The highest-yield biopsy sites can then be selected from this comprehensive microscopic dataset using cross-sectional microscopic morphologic criteria similar to those used for conventional histopathologic diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Esophageal-guided biopsy with volumetric laser endomicroscopy and laser cautery marking: a pilot clinical study

Suter

Gora

Lauwers

et al. 2014

Gastrointestinal Endoscopy

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Background Biopsy surveillance protocols for the assessment of Barrett’s esophagus can be subject to sampling errors, resulting in diagnostic uncertainty. Optical coherence tomography is a cross-sectional imaging technique that can be used to conduct volumetric laser endomicroscopy (VLE) of the entire distal esophagus. We have developed a biopsy guidance platform that places endoscopically visible marks at VLE-determined biopsy sites. Objective The objective of this study was to demonstrate in human participants the safety and feasibility of VLE-guided biopsy in vivo. Design A pilot feasibility study. Setting Massachusetts General Hospital. Patients A total of 22 participants were enrolled from January 2011 to June 2012 with a prior diagnosis of Barrett’s esophagus. Twelve participants were used to optimize the laser marking parameters and the system platform. A total of 30 target sites were selected and marked in real-time by using the VLE-guided biopsy platform in the remaining 10 participants. Intervention Volumetric laser endomicroscopy. Main Outcome Measurements Endoscopic and VLE visibility, and accuracy of VLE diagnosis of the tissue between the laser cautery marks. Results There were no adverse events of VLE and laser marking. The optimal laser marking parameters were determined to be 2 seconds at 410 mW, with a mark separation of 6 mm. All marks made with these parameters were visible on endoscopy and VLE. The accuracies for diagnosing tissue in between the laser cautery marks by independent blinded readers for endoscopy were 67% (95% confidence interval [CI], 47%–83%), for VLE intent-to-biopsy images 93% (95% CI, 78%–99%), and for corrected VLE post-marking images 100% when compared with histopathology interpretations. Limitations This is a single-center feasibility study with a limited number of patients. Conclusion Our results demonstrate that VLE-guided biopsy of the esophagus is safe and can be used to guide biopsy site selection based on the acquired volumetric optical coherence tomography imaging data. (Clinical trial registration number: NCT01439633.)

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“…New imaging technologies, such as narrow band imaging and confocal endomicroscopy, can enhance surface patterns associated with Barrett's esophagus. However, these imaging technologies ultimately require the use of endoscopy with or without topical or intravenous contrast agents [25, 26]. Targeted screening in high risk populations, such as those with chronic reflux who are over the age of 50, with a low cost screening device not requiring sedation would be ideal.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement for the Detection of Barrett’s Esophagus with Optical Frequency Domain Imaging

Sauk

Coron²,

Kava

et al. 2013

Dig Dis Sci

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Background Optical frequency domain imaging (OFDI) is a second-generation form of optical coherence tomography (OCT) providing comprehensive cross-sectional views of the distal esophagus at a resolution of ∼7 μm. Aims Using validated OCT criteria for squamous mucosa, gastric cardia mucosa, and Barrett's Esophagus (BE), the objective of this study was to determine the inter- and intra-observer agreements by a large number of OFDI readers for differentiating these tissues. Methods OFDI images were obtained from 9 subjects undergoing screening and surveillance for BE. 64 OFDI image regions of interest were randomly selected for review. A training set of 19 images was compiled distinguishing squamous mucosa from gastric cardia and BE using previously validated OCT criteria. The 10 readers then interpreted images in a test set of 45 different images of squamous mucosa (n=15), gastric cardia (n=15), or BE (n=15). Interobserver agreement differentiating the three tissue types and BE vs. non-BE mucosa was determined using multi-rater Fleiss's κ value. The images were later randomized and four readers repeated the test three weeks later to assess intraobserver reliability. Results All 10 readers showed excellent agreement for the differentiation of BE vs. non-BE mucosa (κ= 0.811 p<0.0001) and for differentiating BE vs. gastric cardia vs. squamous mucosa (κ=0.866, p<0.0001). For the 4 readers who repeated the test, the median intraobserver agreement (BE vs. non-BE) was high (κ=0.975, IQR: 0.94, 1.0). Conclusions Trained readers have a high interobserver agreement for differentiating BE, squamous, and gastric cardia mucosa using OFDI.

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Added value of narrow band imaging and confocal laser endomicroscopy in detecting Barrett’s esophagus neoplasia

Abstract: HD-WLE in combination with NBI is highly accurate in the detection of HGD/IMC. Performing targeted biopsies in the surveillance of Barrett's esophagus is possible in expert centers.

Cited by 54 publications

References 16 publications

In vivo endomicroscopy improves detection of Barrett's esophagus–related neoplasia: a multicenter international randomized controlled trial (with video)

In vivo endomicroscopy improves detection of Barrett's esophagus–related neoplasia: a multicenter international randomized controlled trial (with video)

Esophageal-guided biopsy with volumetric laser endomicroscopy and laser cautery marking: a pilot clinical study

Interobserver Agreement for the Detection of Barrett’s Esophagus with Optical Frequency Domain Imaging

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