Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response (with videos) - 18/11/12
Reprint requests: Hiroshi Mashimo, MD, PhD, Gastroenterology Section, Veterans Affairs Boston Healthcare System, Harvard School of Medicine, Boston, MA 02130Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : BE, CE-D, CE-IM, GEJ, OCT, RFA, 3-D
Plan
| 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. |
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| If you would like to chat with an author of this article, you may contact Dr Mashimo at hmashimo@hms.harvard.edu. |
Vol 76 - N° 6
P. 1104-1112 - décembre 2012 Retour au numéro
Article précédent
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- Barrett's esophagus: should we burn it all?
- Andrea May
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