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Real-time diagnosis of Barrett’s esophagus: a prospective, multicenter study comparing confocal laser endomicroscopy with conventional histology for the identification of intestinal metaplasia in new users

  • 2018 SAGES Oral
  • Published:
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Abstract

Introduction

Endoscopic evaluation with high-definition white light endoscopy and random 4-quadrant biopsy (Seattle Protocol) is the current standard of care for the detection of Barrett’s esophagus (BE). Recently, enhanced imaging technologies have become available to provide real-time diagnosis of intestinal metaplasia (IM) and dysplasia, reducing the need for tissue biopsy. Probe-based confocal laser endomicroscopy (pCLE) provides dynamic microscopic mucosal views, rapidly capturing digital images that become optical biopsies. This study examined the role of pCLE in BE screening and surveillance as compared to the Seattle Protocol.

Methods

Patients undergoing BE screening or surveillance endoscopy were enrolled at eight US centers. Optical biopsy using pCLE was interpreted in real time. Endoscopists performing pCLE were new users with a median experience of 8.5 months and no formal training in surgical pathology. Seattle Protocol biopsies were then taken. Recorded pCLE images were reviewed by a blinded expert in optical biopsy interpretation.

Results

Early pCLE users identified significantly more patients with IM than the Seattle Protocol overall (99/172 vs. 46/172, p < 0.0001). Early users of pCLE also identified significantly more patients with IM than the Seattle Protocol in the patients with visible columnar lined esophagus (75 vs. 31, p < 0.0001), but not in the 76 patients without columnar lined esophagus (24 vs. 15, p = 0.067). There was no statistically significant difference between early pCLE users and expert review.

Conclusion

Optical biopsy using pCLE technology allows for the real-time evaluation of entire segments of columnar lined esophagus. Consequently, pCLE is considerably more sensitive in the detection of BE than the Seattle Protocol, which leaves a majority of epithelium unexamined. This effect is seen even in new users and increases with experience. Overall, pCLE provides a promising advance in Barrett’s detection which will likely result in superior identification of individuals at risk for esophageal adenocarcinoma.

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References

  1. Sharma P, Brill J, Canto M, DeMarco D, Fennerty B, Gupta N, Loren L, Lieberman D, Lightdale C, Montgomery E, Odze R, Tokar J, Kochman M (2015) White Paper AGA: advanced imaging in Barrett’s esophagus. Clin Gastroenterol Hepatol 13:2209–2218

    Article  PubMed  Google Scholar 

  2. Gupta A, Attar BM, Koduru P, Murali AR, Go BT, Agarwal R (2014) Utility of confocal laser endomicroscopy in identifying high grade dysplasia and adenocarcinoma in Barrett’s esophagus: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 4:369–377

    Article  Google Scholar 

  3. Konda VJ, Chennat JS, Hart J, Waxman I (2010) Confocal laser endomicroscopy: potential in the management of Barrett’s esophagus. Dis Esophagus 5:E21–E31

    Google Scholar 

  4. Bajbouj M, Vieth M, Rosch T, Miehlke S, Becker V, Anders M, Pohl H, Madisch A, Schuster T, Schmid RM, Meining A (2010) Probe-based confocal laser endomicroscopy with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy 42(6):435–440

    Article  CAS  PubMed  Google Scholar 

  5. Johnson E, De Lee R, Agni R, Pfau P, Reichelderfer M, Gopal DV (2012) Probe-based confocal laser endomicroscopy to guide real-time endoscopic therapy in Barrett’s esophagus with dysplasia. Case Rep 6(2):285–292

    Google Scholar 

  6. Burnette J, Zfass A, Roch A, Bagnato J (2015) Utility of Probe-based Confocal Laser Endomicroscopy in screening work-up for Barrett’s esophagus and detection of intestinal metaplasia [Abstract]. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting, Nashville

  7. Pera M, Manterola C, Vidal O et al (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92:151–159

    Article  PubMed  Google Scholar 

  8. Bennett C, Vakil N, Bergman J et al (2012) Consensus statements for management of Barrett’s dysplasia and early-stage esophageal adenocarcinoma, based on a Delphi process. Gastroenterology 143:336–346

    Article  PubMed  PubMed Central  Google Scholar 

  9. Committee ASoP. Evans JA, Early DS et al (2012) The role of endoscopy in Barrett’s esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 76:1087–1094

    Article  Google Scholar 

  10. Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ (2011) American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 140:e18–e52

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kariv R, Plesec TP, Goldblum JR et al (2009) The Seattle protocol does not more reliably predict the detection of cancer at the time of esophagectomy than a less intensive surveillance protocol. Clin Gastroenterol Hepatol 7:653–658

    Article  PubMed  Google Scholar 

  12. Harrison R, Perry I, Haddadin W et al (2007) Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol 102:1154–1161

    Article  PubMed  Google Scholar 

  13. Abrams JA, Kapel RC, Lindberg GM et al (2009) Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol 7:736–742

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sharma P, Allen J et al (2018) Improving quality of care in patients with Barrett’s esophagus by measuring and improving neoplasia detection rates. Gastrointest Endosc 87(5):1195–1197

    Article  PubMed  Google Scholar 

  15. Shaheen NJ, Falk GW, Lyer PG et al (2016) ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 111:30–50

    Article  CAS  PubMed  Google Scholar 

  16. Visrodia K, Singh S, Krishnamoorthi R, Ahlquist DA, Wang KK, Iyer PG, Katzka DA (2016) Systematic review with meta-analysis: prevalent vs. incident oesophageal adenocarcinoma and high-grade dysplasia in Barrett’s oesophagus. Aliment Pharmacol Ther 44(8):775–784

    Article  CAS  PubMed  Google Scholar 

  17. Canto MI, Anandasabapathy S, Brugge W, Falk GW, Dunbar KB, Zhang Z, Woods K, Almario JA, Schell U, Goldblum J, Maitra A, Montgomery E, Kiesslich R (2014) In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial. Gastrointest Endosc 2:211–221

    Article  Google Scholar 

  18. Chandrasoma P, DeMeester T (2016) A New Pathologic Assessment of Gastroesophageal Reflux Disease: The Squamo-Oxyntic Gap. Adv Exp Med Biol 908:41–78

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Northwest Institute for Digestive Surgery, 750 N Syringa St, Ste 205, Post Falls, ID, 83854, USA

    Cory Richardson

  2. Carolinas Medical Center, Charlotte, NC, USA

    Paul Colavita

  3. The Oregon Clinic, Portland, OR, USA

    Christy Dunst

  4. Coliseum Northside Hospital, Macon, GA, USA

    John Bagnato & Joseph Burnette

  5. Puget Sound Surgical Center, Tacoma, WA, USA

    Peter Billing & Kurt Stewart

  6. Bingham Memorial Hospital, Blackfoot, ID, USA

    Kurt Birkenhagen

  7. Scott & White Healthcare, Temple, TX, USA

    Francis Buckley

  8. Houston Northwest Medical Center, Houston, TX, USA

    William Buitrago, Phil Leggett & Thomas Wang

  9. Minnesota Institute for Minimally Invasive Surgery, Crosby, MN, USA

    Howard McCollister & Paul Severson

  10. Virginia Commonwealth University, Richmond, VA, USA

    Alvin Zfass

Authors
  1. Cory Richardson
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  2. Paul Colavita
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  9. Joseph Burnette
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  10. Phil Leggett
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  13. Thomas Wang
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  14. Alvin Zfass
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  15. Paul Severson
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Corresponding author

Correspondence to Cory Richardson.

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Disclosures

Drs. Cory Richardson, Paul Colavita, Christy Dunst, John Bagnato, Peter Billing, Kurt Birkenhagen, Francis Buckley, William Buitrago, Joseph Burnette, Phil Leggett, Howard McCollister, Kurt Stewart, Thomas Wang, Alvin Zfass, and Paul Severson have no conflicts of interest or financial ties to disclose.

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Richardson, C., Colavita, P., Dunst, C. et al. Real-time diagnosis of Barrett’s esophagus: a prospective, multicenter study comparing confocal laser endomicroscopy with conventional histology for the identification of intestinal metaplasia in new users. Surg Endosc 33, 1585–1591 (2019). https://doi.org/10.1007/s00464-018-6420-9

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  • DOI: https://doi.org/10.1007/s00464-018-6420-9

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