P1370 - Seeing the Unseen With VLE

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Samantha Ho, DO, MPH

Kaiser Permanente Medical Center
Oakland, CA, United States

Samantha Ho, DO, MPH, Mitchell Liverant, MD, Benjamin Hassid, MD, Sarah Michael, MD, Howard Chang, MD
Kaiser Permanente Medical Center, Oakland, CA

Introduction: Barrett’s esophagus (BE) is a known precursor to esophageal adenocarcinoma, and early detection of advanced dysplasia can significantly improve outcomes. Nodular Barrett’s esophagus is best visualized by white light endoscopy (WLE) and treated with endoscopic mucosal resection (EMR). Volumetric laser endomicroscopy (VLE) is an advanced imaging system that has been shown to improve diagnostic yield for dysplasia and may increase detection of early neoplasm. This study aims to evaluate the utility of VLE in identifying advanced dysplasia in patients with non-nodular Barrett’s esophagus.

Methods: This retrospective study recruited members of Kaiser Permanente Northern California who had a diagnosis of BE with dysplasia and were referred for endoscopic eradication therapy (EET) from February 2011 to April 2019. VLE was made available to the center starting in June 2015. All consecutive patients were evaluated with WLE and VLE prior to eradication therapy by one of two endoscopists who are trained in using VLE. EMR was performed if nodularity was identified by WLE or if non-nodular mucosa showed advanced dysplastic changes on VLE. Patients were followed every 3 months until complete eradication. The final pathology obtained from WLE-guided or VLE-directed EMR were also compared retrospectively.

Results: A total of 206 patients with dysplastic BE were referred for EET and were categorized by their initial pathology of low grade LGD (37.4%), high grade HGD (46.6%), and adenocarcinoma AC (16%). Demographic consisted of White (75%), Hispanics (11.8%), Blacks (6.3%) and Asians (6.2%). Median Prague classification across LGD, HGD and AC were C2M5, C3M5, C1M4, respectively. A total of 72 EMR cases were performed, with 34 (47.2%) cases directed by VLE and 38 (52.8%) cases guided by WLE. Pathology was upstaged in 11 patients with VLE-directed EMR. 10 of the 11 VLE-directed EMR cases had final pathology consistent with adenocarcinoma.

Discussion: In our study, we found that volumetric laser endomicroscopy (VLE) allowed for the detection of non-nodular adenocarcinoma in 10 of 72 (13.9%) total patients with dysplastic Barrett’s esophagus who underwent EMR and about one quarter (22.5%) of patients with pre-existing high grade dysplasia. This finding highlights that a substantial minority of patients with dysplastic Barrett’s esophagus harbor foci of adenocarcinoma not readily visible with standard endoscopy.

Initial Path of those who underwent EMR (N)	Total number of upstaged Path (%)	White Light Endoscopy-guided EMR		Volumetric Laser Endomicroscopy-directed EMR
Initial Path of those who underwent EMR (N)	Total number of upstaged Path (%)	Number of upstaged Path (%)	Number of AC Final Path (%)	Number of upstaged Path (%)	Number of AC Final Path (%)
LGD (16)	6 (37.5%)	4 (25%)	2 (12.5%)	2 (12.5%)	1 (6.25%)
HGD (40)	18 (45%)	9 (22.5%)	10 (25%)	9 (22.5%)	9 (22.5%)
AC (16)	-	-	-	-	-
TOTAL (72)	24 (33.3%)	13 (18.1%)	12 (16.7%)	11 (15.3%)	10 (13.9%)

Table: Comparison of Cases with Upstaged Pathology and Final Pathology of Adenocarcinoma based on WLE-guided or VLE-directed EMR;

WLE white light endoscopy; VLE volumetric laser endomicroscopy; EMR endoscopic mucosal resection; AC adenocarcinoma; Path pathology.

Disclosures:

Samantha Ho indicated no relevant financial relationships.

Mitchell Liverant indicated no relevant financial relationships.

Benjamin Hassid indicated no relevant financial relationships.

Sarah Michael indicated no relevant financial relationships.

Howard Chang indicated no relevant financial relationships.

Samantha Ho, DO, MPH, Mitchell Liverant, MD, Benjamin Hassid, MD, Sarah Michael, MD, Howard Chang, MD. P1370 - Seeing the Unseen With VLE, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.