Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study
Objective Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there ar...
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BMJ Publishing Group
2019-08-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/6/1/e000340.full |
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| author | Allon Kahn Cadman L Leggett Arvind J Trindade Matthew J McKinley Molly Stewart Kara L Raphael Sumant Inamdar Joshua Berkowitz Anil Vegesna Petros C Benias Calvin Lee Divyesh V Sejpal Arvind Rishi |
| author_facet | Allon Kahn Cadman L Leggett Arvind J Trindade Matthew J McKinley Molly Stewart Kara L Raphael Sumant Inamdar Joshua Berkowitz Anil Vegesna Petros C Benias Calvin Lee Divyesh V Sejpal Arvind Rishi |
| author_sort | Allon Kahn |
| collection | DOAJ |
| description | Objective Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there are in vivo VLE features that can predict gastric cardia dysplasia in BE.Design This was a single-centre observational cohort study from August 2016 to August 2018. Patients were included if they had BE, were undergoing a VLE exam as standard of care, and had a suspicious target laser marked at the gastric cardia. The following VLE features were correlated to histology to determine if an association existed between histology subtype and VLE feature: wide crypts, irregular surface, one large isolated gland, multiple glands, and complex glands.Results A total of 110 in vivo gastric cardia targets in 77 patients with BE were analysed. The following abnormalities were identified: 61 wide crypts, 34 isolated glands, 16 irregular surfaces, 15 multiple glands, and 11 complex glands. Complex glands were the only VLE feature that correlated to any histology subtype. They were present in 71% of targets with high-grade dysplasia (HGD), T1a cancer or T1b cancer and had a sensitivity, specificity, and accuracy of 71%, 99%, and 85%, respectively. Of the 10 patients with complex glands on VLE and HGD/cancer on histology, 4 had a normal-appearing mucosa (40%) on endoscopy.Conclusion Identification of complex glands on VLE may aid in detection of HGD or early cancer in the gastric cardia in BE. This is particularly important, as dysplasia at the gastric cardia can be difficult to see endoscopically. |
| format | Article |
| id | doaj-art-2cd3229a7bf445199ad9f68aa2aca75c |
| institution | OA Journals |
| issn | 2054-4774 |
| language | English |
| publishDate | 2019-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj-art-2cd3229a7bf445199ad9f68aa2aca75c2025-08-20T02:35:49ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742019-08-016110.1136/bmjgast-2019-000340Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort studyAllon Kahn0Cadman L Leggett1Arvind J Trindade2Matthew J McKinley3Molly Stewart4Kara L Raphael5Sumant Inamdar6Joshua Berkowitz7Anil Vegesna8Petros C Benias9Calvin Lee10Divyesh V Sejpal11Arvind Rishi12Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA1 Barrett’s Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA1 Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA1 Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USADivision of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USAObjective Volumetric laser endomicroscopy (VLE) is an advanced imaging modality used in Barrett’s oesophagus (BE) to help identify dysplasia in the oesophagus. VLE criteria exist for oesophageal dysplasia but not for dysplasia in the gastric cardia. The aim of this study was to determine if there are in vivo VLE features that can predict gastric cardia dysplasia in BE.Design This was a single-centre observational cohort study from August 2016 to August 2018. Patients were included if they had BE, were undergoing a VLE exam as standard of care, and had a suspicious target laser marked at the gastric cardia. The following VLE features were correlated to histology to determine if an association existed between histology subtype and VLE feature: wide crypts, irregular surface, one large isolated gland, multiple glands, and complex glands.Results A total of 110 in vivo gastric cardia targets in 77 patients with BE were analysed. The following abnormalities were identified: 61 wide crypts, 34 isolated glands, 16 irregular surfaces, 15 multiple glands, and 11 complex glands. Complex glands were the only VLE feature that correlated to any histology subtype. They were present in 71% of targets with high-grade dysplasia (HGD), T1a cancer or T1b cancer and had a sensitivity, specificity, and accuracy of 71%, 99%, and 85%, respectively. Of the 10 patients with complex glands on VLE and HGD/cancer on histology, 4 had a normal-appearing mucosa (40%) on endoscopy.Conclusion Identification of complex glands on VLE may aid in detection of HGD or early cancer in the gastric cardia in BE. This is particularly important, as dysplasia at the gastric cardia can be difficult to see endoscopically.https://bmjopengastro.bmj.com/content/6/1/e000340.full |
| spellingShingle | Allon Kahn Cadman L Leggett Arvind J Trindade Matthew J McKinley Molly Stewart Kara L Raphael Sumant Inamdar Joshua Berkowitz Anil Vegesna Petros C Benias Calvin Lee Divyesh V Sejpal Arvind Rishi Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study BMJ Open Gastroenterology |
| title | Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study |
| title_full | Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study |
| title_fullStr | Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study |
| title_full_unstemmed | Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study |
| title_short | Volumetric laser endomicroscopy features of dysplasia at the gastric cardia in Barrett’s oesophagus: results from an observational cohort study |
| title_sort | volumetric laser endomicroscopy features of dysplasia at the gastric cardia in barrett s oesophagus results from an observational cohort study |
| url | https://bmjopengastro.bmj.com/content/6/1/e000340.full |
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