Measuring Barrett’s Epithelial Thickness with Volumetric Laser Endomicroscopy as a Biomarker to Guide Treatment

Autor: Michael B. Wallace, Guillermo J. Tearney, Peter D. Siersema, Iris Levink, Herbert C. Wolfsen
Přispěvatelé: Gastroenterology & Hepatology
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Barrett’s esophageal thickness (BET)
Male
Treatment response
Contrast enhancement
Esophageal Mucosa
Physiology
Radiofrequency ablation
Barrett’s esophagus (BE)
Treatment outcome
Clinical Decision-Making
Volumetric laser endomicroscopy (VLE)
law.invention
Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14]
03 medical and health sciences
Barrett Esophagus
All institutes and research themes of the Radboud University Medical Center
0302 clinical medicine
law
Predictive Value of Tests
Image Interpretation
Computer-Assisted
Endomicroscopy
Medicine
Humans
Registries
Aged
Observer Variation
Microscopy
Radiofrequency Ablation
business.industry
Esophageal wall
Lasers
Patient Selection
Radiofrequency ablation (RFA)
Gastroenterology
Esophagoscopes
Reproducibility of Results
Equipment Design
Middle Aged
Laser
030220 oncology & carcinogenesis
Biomarker (medicine)
030211 gastroenterology & hepatology
Original Article
Female
Esophagoscopy
business
Nuclear medicine
Algorithms
Zdroj: Digestive Diseases and Sciences
Digestive Diseases & Sciences, 64(6), 1579-1587. Springer New York
Digestive Diseases and Sciences, 64, 1579-1587
Digestive Diseases and Sciences, 64, 6, pp. 1579-1587
ISSN: 1573-2568
0163-2116
Popis: Background Radiofrequency ablation (RFA) treatment outcomes vary for unknown reasons. One hypothesis is that variations in Barrett’s epithelial thickness (BET) are associated with reduced RFA efficacy for thicker BET and strictures for thinner BET. Volumetric laser endomicroscopy (VLE) is an imaging modality that acquires high-resolution, depth-resolved images of BE. However, the attenuation of light by tissue and the lack of layering in Barrett’s tissue challenge BET measurements and the study of relationships between thickness and RFA outcomes. We aimed to quantify BET and compared the reliability of standard and contrast-enhanced VLE images. Methods Baseline VLE scans from BE patients without prior ablative therapy and a Prague (M) length of > 1 cm were obtained from the US VLE Registry. An algorithm was applied to the VLE images to flatten the mucosal surface and enhance the contrast of different esophageal wall layers. Subsequently, BET was measured by two independent VLE readers using both contrast- and non-contrast-enhanced datasets. In order to validate these adjusted images, intra- and interobserver agreements were calculated. Results VLE scans from fifty-seven patients were included in this study. BET was measured at eight equidistant locations on the selected cross-sectional images at 0.5 cm intervals from the GEJ to the proximal-most extent of BE. The intra-observer coefficients of the two readers for the contrast-enhanced images were 0.818 (95% CI 0.798–0.836) and 0.890 (95% CI 0.878–0.900). The interobserver agreement for the contrast-enhanced images (0.880; 95% CI 0.867–0.891) was significantly better than for the original images (0.778; 95% CI 0.754–0.799). Conclusion We developed an algorithm that improves VLE visualization of the mucosal layers of the esophageal wall and enables rapid and reliable measurement of BET. Interobserver variability measurements were significantly reduced when using contrast enhancement. Studies are underway to correlate BET with treatment response. Electronic supplementary material The online version of this article (10.1007/s10620-018-5453-1) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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