Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry.

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291

Quality of life following radiofrequency ablation of dysplastic Barrett’s esophagus

The impact of the diagnosis and treatment of dysplastic Barrett’s esophagus (BE) on quality of life (QoL) is poorly understood. This study assessed the influence of dysplastic BE on QoL and evaluated if endoscopic treatment of dysplastic BE with radiofrequency ablation (RFA) improves QoL

Safety and efficacy of endoscopic spray cryotherapy for Barrett's esophagus with high-grade dysplasia

Endoscopic ablation to treat Barrett’s esophagus (BE) with high-grade dysplasia (HGD) is associated with a decreased incidence of esophageal adenocarcinoma. Endoscopic spray cryotherapy (CRYO) demonstrates promising preliminary data

Endoscopic spray cryotherapy for esophageal cancer: safety and efficacy

Few options exist for patients with localized esophageal cancer ineligible for conventional therapies. Endoscopic spray cryotherapy with low-pressure liquid nitrogen has demonstrated efficacy in this setting in early studies

Durability of Radiofrequency Ablation in Barrett's Esophagus With Dysplasia

Radiofrequency ablation (RFA) can eradicate dysplasia and intestinal metaplasia in patients with dysplastic Barrett’s esophagus (BE), and reduce rates of esophageal adenocarcinoma. We assessed long-term rates of eradication, durability of neosquamous epithelium, disease progression, and safety of RFA in patients with dysplastic BE

Dedifferentiated liposarcoma of the esophagus: a case report and selected review of the literature

Soft tissue sarcomas of the esophagus represent an extremely rare cause of esophageal masses, and an even smaller proportion of these tumors represent dedifferentiated liposarcomas. We present a case of a 75-yearold gentleman presenting with dysphagia found to have a 5 cm pedunculated mass in the cervical esophagus, originating at the cricopharyngeus. This was found to have involvement limited to the superficial mucosa by endoscopic ultrasound, and the lesion was subsequently resected endoscopically. Pathology demonstrated an undifferentiated pleomorphic sarcoma later determined to represent dedifferentiated liposarcoma after fluorescence in situ hybridization analysis. The patient received no additional adjuvant therapy and remains disease free 20 months from the procedure. While treatment experience is limited, our case demonstrates that in selected patients, sustained local control can be obtained without radical resection

Outcome of long benign esophageal strictures undergoing endoscopictherapy : A tertiary center experience

Complex benign esophageal strictures are defined by length (≥2 cm), small diameter, and stricture angulation or tortuosity. The long-term course of complex esophageal strictures based on length is currently unclear. We suspect that the esophageal stricture length might impact the effectiveness of endoscopic dilation therapy. We performed a retrospective study of all benign esophageal strictures of 2 cm or longer treated at a single center between July 1, 2010, and May 31, 2014. Primary outcomes were changed in dysphagia score at the end of follow-up compared to first dilation at our facility and the need for gastrostomy placement or esophagectomy during follow-up. Data were stratified into four subgroups according to stricture length: 20-29, 30-49, 50-99, and 100 mm or longer. Eighty-seven patients (mean age: 66 years, 54% women) were followed over a median of 40 months. Patients underwent a median of 6 dilations, averaging 0.3 dilations per month. Median dysphagia score remained unchanged at 2; 37 (43%) patients reported resolution or improved dysphagia and 50 (57%) patients reported no improvement or worsened dysphagia. Gastrostomy placement or esophagectomy was needed for 23 (26%) and 3 (3%) patients, respectively. Median degree of dysphagia at the end of follow-up did not differ between the four stricture length subgroups, yet no patient had improvement in the 100 mm or longer subgroup. More than half of patients with long benign esophageal strictures had unchanged dysphagia or developed worse dysphagia during follow-up. Long-term outcomes did not differ between different stricture lengths