Original article Clinical endoscopy| Volume 76, ISSUE 6, P1104-1112, December 2012

Download started.


Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response (with videos)


      Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response.


      Identify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT).




      Single teaching hospital.


      Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment.


      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.


      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).


      Single center, cross-sectional study in which only patients with short-segment BE were examined.


      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.


      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Odze R.D.
        • Lauwers G.Y.
        Histopathology of Barrett's esophagus after ablation and endoscopic mucosal resection therapy.
        Endoscopy. 2008; 40: 1008-1015
        • Bergman J.J.
        Radiofrequency ablation—great for some or justified for many?.
        N Engl J Med. 2009; 360: 2353-2355
        • Ell C.
        • Pech O.
        • May A.
        Radiofrequency ablation in Barrett's esophagus.
        New Engl J Med. 2009; 361 (author reply 1022): 1021
        • Shaheen N.J.
        • Sharma P.
        • Overholt B.F.
        • et al.
        Radiofrequency ablation in Barrett's esophagus with dysplasia.
        N Engl J Med. 2009; 360: 2277-2288
        • Pouw R.
        • Gondrie J.
        • Sondermeijer C.
        • et al.
        Eradication of Barrett esophagus with early neoplasia by radiofrequency ablation, with or without endoscopic resection.
        J Gastrointest Surg. 2008; 12: 1627-1637
        • Dunkin B.
        • Martinez J.
        • Bejarano P.
        • et al.
        Thin-layer ablation of human esophageal epithelium using a bipolar radiofrequency balloon device.
        Surg Endosc. 2006; 20: 125-130
        • Sharma V.K.
        • Wang K.K.
        • Overholt B.F.
        • et al.
        Balloon-based, circumferential, endoscopic radiofrequency ablation of Barrett's esophagus: 1-year follow-up of 100 patients (with video).
        Gastrointest Endosc. 2007; 65: 185-195
        • Shaheen N.J.
        • Overholt B.F.
        • Sampliner R.E.
        • et al.
        Durability of radiofrequency ablation in Barrett's esophagus with dysplasia.
        Gastroenterology. 2011; 141: 460-468
        • Fleischer D.E.
        • Overholt B.F.
        • Sharma V.K.
        • et al.
        Endoscopic radiofrequency ablation for Barrett's esophagus: 5-year outcomes from a prospective multicenter trial.
        Endoscopy. 2010; 42 (,9): 781
        • Vaccaro B.
        • Gonzalez S.
        • Poneros J.
        • et al.
        Detection of intestinal metaplasia after successful eradication of Barrett's esophagus with radiofrequency ablation.
        Dig Dis Sci. 2011; 56: 1996-2000
        • Barr H.
        • Krasner N.
        • Boulos P.B.
        • et al.
        Photodynamic therapy for colorectal cancer—a quantitative pilot-study.
        Br J Surg. 1990; 77: 93-96
        • Johnston M.H.
        Cryotherapy and other newer techniques.
        Gastrointest Endosc Clin N Am. 2003; 13: 491-504
        • Barr H.
        • Stone N.
        • Rembacken B.
        Endoscopic therapy for Barrett's oesophagus.
        Gut. 2005; 54: 875-884
        • Das A.
        • Wells C.
        • Kim H.J.
        • et al.
        An economic analysis of endoscopic ablative therapy for management of nondysplastic Barrett's esophagus.
        Endoscopy. 2009; 41 (408): 400
        • Inadomi J.M.
        • Somsouk M.
        • Madanick R.D.
        • et al.
        A cost-utility analysis of ablative therapy for Barrett's esophagus.
        Gastroenterology. 2009; 136: 210114.e6
        • Huang D.
        • Swanson E.A.
        • Lin C.P.
        • et al.
        Optical coherence tomography.
        Science. 1991; 254: 1178-1181
        • Tearney G.J.
        • Brezinski M.E.
        • Southern J.F.
        • et al.
        Optical biopsy in human gastrointestinal tissue using optical coherence tomography.
        Am J Gastroenterol. 1997; 92: 1800-1804
        • Bouma B.E.
        • Tearney G.J.
        • Compton C.C.
        • et al.
        High-resolution imaging of the human esophagus and stomach in vivo using optical coherence tomography.
        Gastrointest Endosc. 2000; 51: 467-474
        • Li X.D.
        • Boppart S.A.
        • Van Dam J.
        • et al.
        Optical coherence tomography: advanced technology for the endoscopic imaging of Barrett's esophagus.
        Endoscopy. 2000; 32: 921-930
        • Poneros J.M.
        Diagnosis of Barrett's esophagus using optical coherence tomography.
        Gastrointest Endosc Clin N Am. 2004; 14: 573-588
        • Evans J.A.
        • Nishioka N.S.
        The use of optical coherence tomography in screening and surveillance of Barrett's esophagus.
        Clin Gastroenterol Hepatol. 2005; 3: S8-S11
        • Chen Y.
        • Aguirre A.D.
        • Hsiung P.L.
        • et al.
        Ultrahigh resolution optical coherence tomography of Barrett's esophagus: preliminary descriptive clinical study correlating images with histology.
        Endoscopy. 2007; 39: 599-605
        • Adler D.C.
        • Zhou C.
        • Tsai T.H.
        • et al.
        Three-dimensional optical coherence tomography of Barrett's esophagus and buried glands beneath neosquamous epithelium following radiofrequency ablation.
        Endoscopy. 2009; 41: 773-776
        • Suter M.J.
        • Vakoc B.J.
        • Yachimski P.S.
        • et al.
        Comprehensive microscopy of the esophagus in human patients with optical frequency domain imaging.
        Gastrointest Endosc. 2008; 68: 745-753
        • Adler D.C.
        • Zhou C.
        • Tsai T.H.
        • et al.
        Three-dimensional endomicroscopy of the human colon using optical coherence tomography.
        Optics Express. 2009; 17: 784-796
        • Zhou C.
        • Adler D.C.
        • Becker L.
        • et al.
        Effective treatment of chronic radiation proctitis using radiofrequency ablation.
        Ther Adv Gastroenterol. 2009; 2: 149-156
        • Isenberg G.
        • Sivak M.V.
        • Chak A.
        • et al.
        Accuracy of endoscopic optical coherence tomography in the detection of dysplasia in Barrett's esophagus: a prospective, double-blinded study.
        Gastrointest Endosc. 2005; 62: 825-831
      1. Zhou C, Tsai TH, Lee HC, et al. Characterization of buried glands pre- and post-radiofrequency ablation using three dimensional optical coherence tomography. Gastrointest Endosc. Epub 2012 Apr 4.

        • Sharma P.
        • Dent J.
        • Armstrong D.
        • et al.
        The development and validation of an endoscopic grading system for Barrett's esophagus: The Prague C & M Criteria.
        Gastroenterology. 2006; 131: 1392-1399
        • Adler D.C.
        • Chen Y.
        • Huber R.
        • et al.
        Three-dimensional endomicroscopy using optical coherence tomography.
        Nature Photonics. 2007; 1: 709-716
        • Trunzo J.
        • McGee M.
        • Poulose B.
        • et al.
        A feasibility and dosimetric evaluation of endoscopic radiofrequency ablation for human colonic and rectal epithelium in a treat and resect trial.
        Surgical Endoscopy. 2011; 25: 491-496
        • Bhat S.
        • Coleman H.G.
        • Yousef F.
        • et al.
        Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study.
        J Natl Cancer Inst. 2011; 103: 1049-1057
        • Hvid-Jensen F.
        • Pedersen L.
        • Drewes Ar.M.
        • et al.
        Incidence of adenocarcinoma among patients with Barrett's esophagus.
        New Engl J Med. 2011; 365: 1375-1383
        • Spechler S.J.
        • Lee E.
        • Ahnen D.
        • et al.
        Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease—follow-up of a randomized controlled trial.
        JAMA. 2001; 285: 2331-2338
      2. Howlader N, Noone NA, Krapcho M, et al, (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). National Cancer Institute. Bethesda, MD,, based on November 2011 SEER data submission, posted to the SEER Web site, April 2012.

        • Hayeck T.J.
        • Kong C.Y.
        • Spechler S.J.
        • et al.
        The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data.
        Dis Esophagus. 2010; 23: 451-457
        • Wang K.K.
        • Sampliner R.E.
        Updated Guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus.
        Am J Gastroenterol. 2008; 103: 788-797
        • Spechler S.J.
        • Sharma P.
        • Souza R.F.
        • et al.
        American Gastroenterological Association technical review on the management of Barrett's esophagus.
        Gastroenterology. 2011; 140: e18-e52
        • Westphal V.
        • Rollins A.M.
        • Willis J.
        • et al.
        Correlation of endoscopic optical coherence tomography with histology in the lower GI tract.
        Gastrointest Endosc. 2005; 61: 537-546