Published online Jul 16, 2017. doi: 10.4253/wjge.v9.i7.319
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
To determine specific volumetric laser endomicroscopy (VLE) imaging features associated with neoplasia at the gastroesophageal junction (GEJ) and gastric cardia.
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.
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).
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.
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.