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Gastrointest Endosc. 2012 Dec;76(6):1104-12. doi: 10.1016/j.gie.2012.05.024. Epub 2012 Jul 24.

Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response (with videos).

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1
Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.

Abstract

BACKGROUND:

Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response.

OBJECTIVE:

Identify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT).

DESIGN:

Cross-sectional.

SETTING:

Single teaching hospital.

PATIENTS:

Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment.

INTERVENTION:

Patients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident.

MAIN OUTCOME MEASUREMENTS:

The thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically.

RESULTS:

BE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy).

LIMITATIONS:

Single center, cross-sectional study in which only patients with short-segment BE were examined.

CONCLUSION:

Three-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.

Comment in

PMID:
22831857
PMCID:
PMC3485415
DOI:
10.1016/j.gie.2012.05.024
[Indexed for MEDLINE]
Free PMC Article
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