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Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos).

ABSTRACT: Radiofrequency ablation (RFA) is an endoscopic technique used to eradicate Barrett's esophagus (BE). However, such ablation can commonly lead to neosquamous epithelium overlying residual BE glands not visible by conventional endoscopy and may evade detection on random biopsy samples.To demonstrate the capability of endoscopic 3-dimensional optical coherence tomography (3D-OCT) for the identification and characterization of buried glands before and after RFA therapy.Cross-sectional study.Single teaching hospital.Twenty-six male and 1 female white patients with BE undergoing RFA treatment.3D-OCT was performed at the gastroesophageal junction in 18 patients before attaining complete eradication of intestinal metaplasia (pre-CE-IM group) and in 16 patients after CE-IM (post-CE-IM group).Prevalence, size, and location of buried glands relative to the squamocolumnar junction.3D-OCT provided an approximately 30 to 60 times larger field of view compared with jumbo and standard biopsy and sufficient imaging depth for detecting buried glands. Based on 3D-OCT results, buried glands were found in 72% of patients (13/18) in the pre-CE-IM group and 63% of patients (10/16) in the post-CE-IM group. The number (mean [standard deviation]) of buried glands per patient in the post-CE-IM group (7.1 [9.3]) was significantly lower compared with the pre-CE-IM group (34.4 [44.6]; P = .02). The buried gland size (P = .69) and distribution (P = .54) were not significantly different before and after CE-IM.A single-center, cross-sectional study comparing patients at different time points in treatment. Lack of 1-to-1 coregistered histology for all OCT data sets obtained in vivo.Buried glands were frequently detected with 3D-OCT near the gastroesophageal junction before and after radiofrequency ablation.

SUBMITTER: Zhou C

PROVIDER: S-EPMC3396122 | biostudies-literature | 2012 Jul

REPOSITORIES: biostudies-literature

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Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos).

Zhou Chao C Tsai Tsung-Han TH Lee Hsiang-Chieh HC Kirtane Tejas T Figueiredo Marisa M Tao Yuankai K YK Ahsen Osman O OO Adler Desmond C DC Schmitt Joseph M JM Huang Qin Q Fujimoto James G JG Mashimo Hiroshi H

Gastrointestinal endoscopy 20120405 1

<h4>Background</h4>Radiofrequency ablation (RFA) is an endoscopic technique used to eradicate Barrett's esophagus (BE). However, such ablation can commonly lead to neosquamous epithelium overlying residual BE glands not visible by conventional endoscopy and may evade detection on random biopsy samples.<h4>Objective</h4>To demonstrate the capability of endoscopic 3-dimensional optical coherence tomography (3D-OCT) for the identification and characterization of buried glands before and after RFA t ...[more]

PMID: 22482920

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Project description:BackgroundRadiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response.ObjectiveIdentify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT).DesignCross-sectional.SettingSingle teaching hospital.PatientsThirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment.InterventionPatients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident.Main outcome measurementsThe thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically.ResultsBE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy).LimitationsSingle center, cross-sectional study in which only patients with short-segment BE were examined.ConclusionThree-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.

Dataset Information

Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos).

Publications

Characterization of buried glands before and after radiofrequency ablation by using 3-dimensional optical coherence tomography (with videos).

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