Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett’s esophagus (with videos)

• Published in: Gastrointestinal endoscopy Vol. 82; no. 4; pp. 631 - 640
• Main Authors: Wolfsen, Herbert C., MD, Sharma, Prateek, MD, Wallace, Michael B., MD, MPH, Leggett, Cadman, MD, Tearney, Guillermo, MD, PhD, Wang, Kenneth K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Adult; Aged; Aged, 80 and over; Barrett Esophagus - pathology; Barrett Esophagus - surgery; Biopsy; Esophagoscopy - instrumentation; Esophagoscopy - methods; Esophagus - pathology; Esophagus - surgery; Feasibility Studies; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Mucous Membrane - pathology; Mucous Membrane - surgery; Patient Safety; Prospective Studies; Tomography, Optical Coherence - instrumentation; Tomography, Optical Coherence - methods; OCT; volumetric laser endomicroscopy; BE; optical coherence tomography; Barrett's esophagus; confocal laser endomicroscopy; OFDI; CLE; optical frequency domain imaging; VLE
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2015.03.1968

Background Volumetric laser endomicroscopy (VLE) produces high-resolution, cross-sectional surface, and subsurface images for detecting neoplasia, targeting biopsies, and guiding real-time treatment. Objective To evaluate the safety and feasibility of the Nvision VLE system. Design Prospective, multicenter study. Setting Tertiary-care medical centers. Patients One hundred patients with suspected Barrett’s esophagus, including 52 patients with prior endotherapy. Interventions The first-generation Nvision VLE Imaging System, a balloon-centered, rotating optical probe provided images of the mucosa and submucosa through a 6-cm segment length and 360° scan of the distal esophagus. Main Outcome Measurements Acquisition of a complete, 6-cm scan from the distal esophagus, demographic and procedural data, and final histologic diagnosis. Results VLE imaging was successfully performed in 87 cases. After VLE imaging, biopsy specimens were obtained in 77 patients and mucosal resection was performed in 20 patients. The final pathologic diagnoses of the patients studied were adenocarcinoma (4 patients), high-grade dysplasia (10 patients), low-grade dysplasia (11 patients), indefinite (5 patients), intestinal metaplasia (29 patients), and normal squamous cells (18 patients). VLE was not completed in 13 of 100 (13%) because of optical probe and console issues. There were 2 minor adverse events (mucosal lacerations not requiring therapy). Limitations This was a feasibility study with a first-generation device. There was no direct histopathologic correlation with the VLE images or any comparative analysis with white-light endoscopy or narrow-band imaging findings. Conclusion VLE is a safe procedure for patients with suspected or confirmed Barrett’s esophagus. Real-time VLE images enabled visualization of the mucosa and submucosa in 87% of cases. Further studies are needed to evaluate the in vivo diagnostic accuracy and clinical utility of VLE.