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Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study
  1. Arvind J Trindade1,
  2. Kara L Raphael1,
  3. Sumant Inamdar1,
  4. Molly Stewart1,
  5. Joshua Berkowitz1,
  6. Anil Vegesna1,
  7. Matthew J McKinley1,
  8. Petros C Benias1,
  9. Allon Kahn2,
  10. Cadman L Leggett3,
  11. Calvin Lee1,
  12. Divyesh V Sejpal1,
  13. Arvind Rishi1
  1. 1Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
  2. 2Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
  3. 3Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Arvind J Trindade; arvind.trindade{at}gmail.com

Abstract

Objective Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there are in vivo VLE features that can predict gastric cardia dysplasia in BE.

Design This was a single-centre observational cohort study from August 2016 to August 2018. Patients were included if they had BE, were undergoing a VLE exam as standard of care, and had a suspicious target laser marked at the gastric cardia. The following VLE features were correlated to histology to determine if an association existed between histology subtype and VLE feature: wide crypts, irregular surface, one large isolated gland, multiple glands, and complex glands.

Results A total of 110 in vivo gastric cardia targets in 77 patients with BE were analysed. The following abnormalities were identified: 61 wide crypts, 34 isolated glands, 16 irregular surfaces, 15 multiple glands, and 11 complex glands. Complex glands were the only VLE feature that correlated to any histology subtype. They were present in 71% of targets with high-grade dysplasia (HGD), T1a cancer or T1b cancer and had a sensitivity, specificity, and accuracy of 71%, 99%, and 85%, respectively. Of the 10 patients with complex glands on VLE and HGD/cancer on histology, 4 had a normal-appearing mucosa (40%) on endoscopy.

Conclusion Identification of complex glands on VLE may aid in detection of HGD or early cancer in the gastric cardia in BE. This is particularly important, as dysplasia at the gastric cardia can be difficult to see endoscopically.

  • oesophageal cancer
  • advanced imaging
  • ablation
  • dysplasia

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Footnotes

  • AJT and KLR contributed equally.

  • Contributors Conception and design: AT. Analysis and interpretation of the data: AT, KLR, SI, AR. Drafting of the article: AT, KLR, SI, MS, JB, AV, MMcK, PB, AK, CLeg, CLee, DS, AR. Critical revision of the article for important intellectual content: AT, KLR, SI, MS, JB, AV, MMcK, PB, AK, CLeg, CLee, DS, AR. Final approval of the article: AT, KLR, SI, MS, JB, AV, MMcK, PB, AK, CLeg, CLee, DS, AR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board (IRB) approval was granted by the Zucker School of Medicine at Hofstra/Northwell (IRB number 17-0033).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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