World Congress at ACG2017

Simultaneous Plenary Session 4B: Esophagus / Colon

67 - Incremental Yield of Dysplasia Detection in Barrett’s Esophagus Using Volumetric Laser Endomicroscopy With and Without Laser Marking Compared to a Standardized Random Biopsy Protocol

Wednesday, October 18
9:10 AM - 9:20 AM
Location: Valencia Ballroom D (Level 4)



Category: Esophagus       

Mohammad Alshelleh, MD1, Sumant Inamdar, MD, MPH2, Dennis Han, MD3, Jeffrey Novak, MD4, Keith Sultan, MD, FACG5, Bethany Devito, MD, FACG6, Mary Cheung, MD7, Petros Benias, MD8, Divyesh V. Sejpal, MD2, Matthew McKinley, MD, FACG, FACP9, Arvind Trindade, MD10
1Hofstra Northwell School of Medicine, Northwell Health System, Bronx, NY; 2Hofstra Northwell School of Medicine, Manhasset, NY; 3Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY; 4Northwell University Hospital, Wantagh, NY; 5Northwell Health, Great Neck, NY; 6Northwell Hofstra School of Medicine, Great Neck, NY; 7Hofstra North Shore-LIJ School of Medicine, Northwell Health System, Great Neck, NY; 8Hofstra North Shore-LIJ School of Medicine, Manhasset, NY; 9ProHealth Care Associates, Lake Success, NY; 10Long Island Jewish Medical Center, New Hyde Park, NY
Introduction: Volumetric laser endomicroscopy (VLE) is a new wide field advanced imaging technology that can detect microstructure changes of dysplasia in Barrett’s esophagus (BE) and target it by placing laser marks in the suspicious areas. Although data exists on safety and efficacy there is no data on the incremental yield of dysplasia detection. Our aim is to report the incremental yield of dysplasia detection in BE using VLE with laser marking.

Methods: This is a retrospective study from 2011-2017 comparing the dysplasia yield of four consecutive groups of patients undergoing surveillance in an academic BE tertiary care referral center. The first group received just random biopsies (NSP), the second group Seattle protocol random biopsies (SP+), the third group received surveillance using VLE without laser marking (VLEL-) and the fourth group received VLE with laser marking (VLEL+). Patients with raised lesions or lesions targeted by narrow band imaging were excluded. Use of VLE was based on availability. VLE was available starting 2014 and thus most of the cases in 2014 and almost all in 2015-2017 involved VLE.

Results: A total of 386 consecutive patients (53 NSP, 92 SP+, 149 VLEL- and 92 VLEL+) that met inclusion criteria were included in the analysis. The total dysplasia yield was 5.66%, 19.56, 24.82% and 33.69% respectively. When compared to just the SP+ group, VLEL+ had statistically higher rates of dysplasia yield over SP+ (P=0.0306). The total advanced neoplasia yield was 3.77%, 1.09%, 11.4%%, and 14.13% respectively. When compared to just the SP+ and VLE- groups, VLEL+ had statistically higher rates of advanced neoplasia yield (P=0.0009 and 0.0032) respectively. When compared to the control group there was a statistically higher rate of EMR performed of non-raised areas in the VLEL- (6%) and VLEL+ group (15%) (p=0.02 and 0.001) .

Discussion: In our cohort VLEL+ lead to statistically significant higher yield of dysplasia detection compared to a standard random biopsy protocol. In addition, VLEL+ may allow for more endoscopic resection of dysplasia due to more precise targeting that may allow pathologists to detect more dysplasia. These results support the use of VLEL+ for surveillance in BE in academic centers but need to be replicated in a prospective study in the community; as tertiary care referral bias can affect the results (eg. patients more like to be surveyed with low-grade dysplasia in a tertiary care setting).

Supported by Industry Grant: No
























































 



Seattle Protocol Biopsy



Non Seattle Protocol Random Biopsy


P-Value

Non Laser marking VLE directed Biopsy


P-Value

Laser marking VLE directed Biopsy


P-Value
Yield of Indefinite for Dysplasia 5.43%

1.89%



0.3042



7.38%



0.5554



11.96%



0.1170


Yield of LGD 13.04% 0% 0.0062 6.04% 0.0617 7.6% 0.2265
Yield of neoplasia (HGD/IMCA) 1.09% 3.77% 0.2766 11.4% 0.0032 14.13% 0.0009
Overall dysplasia/neoplasia yield

19.56%


5.66% 0.0224 24.82% 0.3455 33.69% 0.0306

Patient and Procedure Characteristics







































































































 

Seattle Protocol Biopsy
N=92



Non Seattle Protocol Random Biopsy
N=53


P-Value

Non Laser marking VLE directed Biopsy
N=149


P-Value

Laser marking VLE directed Biopsy
N=92


P-Value
Age, mean (years)

66



65



0.6758



66


 



0.7597



67


 



0.3664


Female 32.61% 26.42% 0.4365 27.52% 0.3998

28.26%


0.5225
Hiatal Hernia 71.74% 43.4% 0.0008 38.92% <0.0001 29.34% <0.0001
Median Length of Barrett’s (cm) 3 cm

1 cm


<0.0001 2 cm 0.2543 3 cm 0.4354
Average Length of Barrett’s (cm)  3.36 cm 1.61 cm

<0.0001



3.37 cm


0.9799 3.68 cm 0.4283
Baseline stricture 11.87% 0% 0.0093 2.68% 0.0041 0% 0.0007
Percentage General Anesthesia 3.26%

3.77%


0.8716 10.73% 0.0369 22.83% 0.0001
Percentage EMR 0%

3.77%


0.0616 6.04% 0.0165 15.22% 0.0001
Percentage with Seattle protocol Biopsies performed 100% 0% <0.0001 25.5% <0.0001 30.43 % <0.0001

Citation: . INCREMENTAL YIELD OF DYSPLASIA DETECTION IN BARRETT’S ESOPHAGUS USING VOLUMETRIC LASER ENDOMICROSCOPY WITH AND WITHOUT LASER MARKING COMPARED TO A STANDARDIZED RANDOM BIOPSY PROTOCOL. Program No. 67. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Mohammad Alshelleh

Trainee
(1) Hofstra Northwell School of Medicine, Northwell Health System
Bronx, CT, US

Presentation(s):

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67 - Incremental Yield of Dysplasia Detection in Barrett’s Esophagus Using Volumetric Laser Endomicroscopy With and Without Laser Marking Compared to a Standardized Random Biopsy Protocol



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