Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2017; 9(7): 319-326
Published online Jul 16, 2017. doi: 10.4253/wjge.v9.i7.319
Use of volumetric laser endomicroscopy for dysplasia detection at the gastroesophageal junction and gastric cardia
Nina Gupta, Uzma Siddiqui, Irving Waxman, Christopher Chapman, Ann Koons, Vesta Valuckaite, Shu-Yuan Xiao, Namrata Setia, John Hart, Vani Konda
Nina Gupta, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60616, United States
Uzma Siddiqui, Irving Waxman, Christopher Chapman, Ann Koons, Vesta Valuckaite, Vani Konda, Center of Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medical Center, Chicago, IL 60616, United States
Shu-Yuan Xiao, Namrata Setia, John Hart, Department of Pathology, University of Chicago Medical Center, Chicago, IL 60616, United States
Author contributions: Gupta N designed and performed the research, performed the statistical analysis, and wrote the paper; Siddiqui U, Waxman I and Chapman C provided clinical advice and contributed to the data set; Koons A and Valuckaite V provided administrative support for VLE system use and patient participation; Xiao SY, Setia N and Hart J performed histologic analysis; Konda V designed the research and supervised the report
Institutional review board statement: This study was reviewed and approved by the IRB committee of the University of Chicago.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after the patient agreed to treatment and VLE imaging by written consent.
Conflict-of-interest statement: We have no relevant financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nina Gupta, MD, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Ave., MC 3051, Chicago, IL 60616, United States. nina.gupta@uchospitals.edu
Telephone: +1-773-7026840 Fax: +1-773-7022230
Received: September 22, 2016
Peer-review started: September 23, 2016
First decision: November 21, 2016
Revised: January 7, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: July 16, 2017
Processing time: 285 Days and 18.2 Hours
Abstract
AIM

To determine specific volumetric laser endomicroscopy (VLE) imaging features associated with neoplasia at the gastroesophageal junction (GEJ) and gastric cardia.

METHODS

During esophagogastroduodenoscopy for patients with known or suspected Barrett’s esophagus, VLE was performed before biopsies were taken at endoscopists’ discretion. The gastric cardia was examined on VLE scan from the GEJ (marked by top of gastric folds) to 1 cm distal from the GEJ. The NinePoints VLE console was used to analyze scan segments for characteristics previously found to correlate with normal or abnormal mucosa. Glands were counted individually. Imaging features identified on VLE scan were correlated with biopsy results from the GEJ and cardia region.

RESULTS

This study included 34 cases. Features characteristic of the gastric cardia (gastric rugae, gastric pit architecture, poor penetration) were observed in all (100%) scans. Loss of classic gastric pit architecture was common and there was no difference between those with neoplasia and without (100% vs 74%, P = NS). The abnormal VLE feature of irregular surface was more often seen in patients with neoplasia than those without (100% vs 18%, P < 0.0001), as was heterogeneous scattering (86% vs 41%, P < 0.005) and presence of anomalous glands (100% vs 59%, P < 0.05). The number of anomalous glands did not differ between individual histologic subgroups (ANOVA, P = NS).

CONCLUSION

The transition from esophagus to gastric cardia is reliably identified on VLE. Histologically abnormal cardia mucosa produces abnormal VLE features. Optical coherence tomography algorithms can be expanded for use at the GEJ/cardia.

Keywords: Volumetric laser endomicroscopy; Cardia; Gastroesophageal junction; Barrett’s; Optical coherence tomography; Neoplasia

Core tip: This is a retrospective study to explore volumetric laser endomicroscopy (VLE) imaging features associated with neoplasia at the gastroesophageal junction (GEJ) and gastric cardia. Histologically abnormal mucosa due to inflammation or neoplasia more often produces abnormal VLE imaging. Specifically, VLE imaging features of irregular surface, heterogeneous scattering and presence of anomalous glands were more often seen in cases of neoplasia than those without. The GEJ and gastric cardia can be difficult to assess endoscopically for dysplasia, and VLE imaging in this area can aid in a “red-flag” biopsy technique.