Optical Biopsy with Probe-based Confocal Laser Endomicroscopy for Prediction of Residual Barrett’s Esophagus after Complete Radiofrequency Ablation (RFA)– A Pilot Study

Abstract

Introduction: Radiofrequency ablation (RFA) of Barrett’s esophagus (BE) is associated with a high rate of complete eradication and a reduced risk of disease progression. Nevertheless, recent data indicate that about one third of patients had disease recurrence after reaching complete remission. Aim: To evaluate whether probe-based confocal laser endomicroscopy (pCLE) can determine complete eradication of BE as compared to histopathology from biopsy after complete RFA for optimized diagnosis in real-time and guide subsequent therapy. Materials and Methods: Consecutive patients undergoing RFA for treatment of BE were prospectively included. pCLE was performed after complete eradication (CE) of dysplasia (CE-D) or intestinal metaplasia (CE-IM) was reached. CE was defined as complete eradication of BE as documented by histopathology obtained from mucosal biopsies. Residual BE was defined as the presence of intestinal metaplasia or dysplasia in standard surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. Results: Based on histopathological analysis 33% of patients (3/9) had high-grade dysplasia, and 67% (6/9) had low-grade dysplasia. RFA was successfully performed in all patients (median age 60±10 yrs.). Three (33%) patients underwent endoscopic mucosal resection (EMR) followed by RFA. Patients received a median of 3±0.6 treatment sessions of RFA after which EGD with biopsies and pCLE were performed. pCLE documented CE-D and CE-IM in 78% and 44% of patients, while histology did in 90% and 67% respectively. Overall sensitivity, specificity, and accuracy of pCLE for real time diagnosis of residual BE after completed RFA treatment was 80% (95% CI 0.43–0.98), 75% (95% CI 0.28–0.98), and 78% (95% CI 0.36–0.98), respectively. Positive and negative predictive values were 80% (95% CI 0.42–0.98) and 75% (95% CI 0.28–0.98). Conclusion: pCLE is yet not reliable for In vivo diagnosis of residual BE after complete RFA in real time. Larger, prospective studies are now highly warranted to further proof this initial concept.