Background
Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but
often involves multiple endoscopy sessions over several months to achieve complete
response.
Objective
Identify structural markers that correlate with treatment response by using 3-dimensional
(3-D) optical coherence tomography (OCT; 3-D OCT).
Design
Cross-sectional.
Setting
Single teaching hospital.
Patients
Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing
RFA treatment.
Intervention
Patients 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 Measurements
The 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.
Results
BE 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).
Limitations
Single center, cross-sectional study in which only patients with short-segment BE
were examined.
Conclusion
Three-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.
Abbreviations:
BE (Barrett's esophagus), CE-D (complete eradication of dysplasia), CE-IM (complete eradication of intestinal metaplasia), GEJ (gastroesophageal junction), OCT (optical coherence tomography), RFA (radiofrequency ablation), 3-D (three-dimensional)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 26, 2012
Accepted:
May 17,
2012
Received:
February 29,
2012
Footnotes
DISCLOSURE: This work was supported by the Massachusetts Institute of Technology(MIT)/CIMIT Medical Engineering Fellowship (T.H.T.), the Veterans Affairs Boston Healthcare System, NIH grants R01-CA75289-15 (J.G.F. and H.M.), R44CA101067-06 (J.G.F.), and K99-EB010071-01A1 (C.Z.), Air Force Office of Scientific Research grant FA9550-10-1-0063 (J.G.F.) and Medical Free Electron Laser Program grant FA9550-10-1-0551 (J.G.F.). D. Adler and J. Schmitt are full-time employees of Lightlab Imaging Inc, St. Jude Medical. J. Fujimoto receives royalties from intellectual property owned by MIT and licensed to Lightlab Imaging Inc, St. Jude Medical and royalties from intellectual property owned by MIT and licensed to Carl Zeiss Meditec and is a scientific advisor for and has stock options with Optovue, Inc. No other financial relationships relevant to this publication were disclosed.
If you would like to chat with an author of this article, you may contact Dr Mashimo at [email protected]
Identification
Copyright
© 2012 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
