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

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 efcacy 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 fatten the mucosal surface and enhance the contrast of diferent 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 ffty-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 coefcients 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 signifcantly 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 signifcantly reduced when using contrast enhancement. Studies are underway to correlate BET with treatment response.

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