VLE predicts complete remission of intestinal metaplasia, dysplasia in BE

SAN DIEGO — Volumetric laser endomicroscopy results that are negative for suspicious findings strongly correlate with histopathologic confirmation of complete remission of intestinal metaplasia and dysplasia in patients who have undergone Barrett’s esophagus eradication, according to interim data presented at DDW 2016.

Perspective from Lauren Gerson, MD, MSc

“Volumetric laser endomicroscopy is a second generation [optical coherence tomography] imaging device capable of producing high-resolution, wide field, cross-sectional imaging of the GI lumen,” Brooks D. Cash, MD, from the University of South Alabama Medical Center, and Healio Gastroenterology Peer Perspective Board member, said during his presentation. “Through this imaging we’re able to obtain a 6 cm continuous circumferential assessment of the GI mucosa and submucosa to a depth of 3 mm and a resolution of 7 micrometers.”

Brooks D. Cash

Cash and colleagues performed an interim analysis on a U.S. multicenter registry that prospectively collected data on patients undergoing VLE performed with the NvisionVLE Imaging System (NinePoint Medical). Their analysis included 152 procedures performed in 130 patients (mean age, 67 years; 82% men) who were seen for surveillance after Barrett’s esophagus treatment, including tissue resection or field ablation.

“Our current study question was: in patients with BE who have completed ablation, does a negative VLE scan correlate with complete remission of intestinal metaplasia and complete remission of dysplasia?” Cash said.

White light endoscopy results were suspicious for BE or dysplasia in 71 procedures, 15 of which had focally suspicious regions. VLE found areas of concern in 66% of the 71 procedures and in 80% of the 15 procedures with focally suspicious regions.

Importantly, white light endoscopy results were normal in 81 procedures, VLE found areas of concern in 36% of them, and targeted biopsies showed non-dysplastic BE in 14% and low grade dysplasia in 3%.

Random biopsies were performed in 51 of the 52 procedures in patients with both normal white light endoscopy and VLE results, and found abnormal histology (non-dysplastic intestinal metaplasia in three patients and low-grade dysplasia in one) in 8%.

“In conclusion, VLE identified lesions suspicious for residual or recurrent intestinal metaplasia or dysplasia in 36% of post-ablation cases with normal white light endoscopy findings, and VLE-targeted biopsies showed intestinal metaplasia or dysplasia in 17% of these procedures,” Cash said. “A negative finding on both white light endoscopy and VLE correctly predicted complete remission of dysplasia in 98% of cases and complete remission of intestinal metaplasia in 92%. Importantly, the negative predictive value of VLE alone was 97% for dysplasia remission.” – by Adam Leitenberger

Reference:

Cash BD, et al. Abstract #61. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosures: Cash reports financial relationships with Actavis plc, IM HealthScience, Ironwood, Salix and Takeda. Please see the DDW disclosure list for all other researchers’ relevant financial disclosures.

Editor's Note: This article was updated to reflect additional information from the presenter.

Perspective

Lauren Gerson, MD, MSc

This multicenter study looked at volumetric laser endomicroscopy, or VLE, for patients with Barrett’s esophagus who had undergone ablation for low or high grade dysplasia. VLE uses advanced optical coherence tomography for real-time cross-sectional imaging. The VLE probe contains a scanning laser within a balloon and is placed through the endoscope channel.

Cash and colleagues demonstrated that usage of VLE was able to identify areas of dysplasia not seen by standard white light endoscopy. The number needed to test with VLE to find a case where the pathology was upstaged was 6.4.

Critiques of this study include the fact that VLE may add on a significant amount of time to standard Seattle protocol. In addition, the learning curve for VLE deserves further study as does the accuracy of VLE operators in the prediction of degree of dysplasia. Therefore, the “real-time applicability” of VLE deserves further study and the findings of this study may require validation in community centers.

Lauren Gerson, MD, MSc

Director of Clinical Research, California Pacific Medical Center

Associate Clinical Professor of Medicine, University of California San Francisco

Disclosures: Gerson reports consulting for Endogastric Solutions, Capsovision, Ironwood Pharmaceuticals, Motus GI Medical, Takeda and Olympus America, and speaking and teaching fees from Takeda.