Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
Gastrointest Endosc. 2018 Jul;88(1):35-42. doi: 10.1016/j.gie.2018.01.032. Epub 2018 Feb 2.
Volumetric laser endomicroscopy (VLE) is a new wide-field advanced imaging technology for Barrett's esophagus (BE). No data exist on incremental yield of dysplasia detection. Our aim is to report the incremental yield of dysplasia detection in BE using VLE.
This is a retrospective study from a prospectively maintained database from 2011 to 2017 comparing the dysplasia yield of 4 different surveillance strategies in an academic BE tertiary care referral center. The groups were (1) random biopsies (RB), (2) Seattle protocol random biopsies (SP), (3) VLE without laser marking (VLE), and (4) VLE with laser marking (VLEL).
A total of 448 consecutive patients (79 RB, 95 SP, 168 VLE, and 106 VLEL) met the inclusion criteria. After adjusting for visible lesions, the total dysplasia yield was 5.7%, 19.6%, 24.8%, and 33.7%, respectively. When compared with just the SP group, the VLEL group had statistically higher rates of overall dysplasia yield (19.6% vs 33.7%, P = .03; odds ratio, 2.1, P = .03). Both the VLEL and VLE groups had statistically significant differences in neoplasia (high-grade dysplasia and intramucosal cancer) detection compared with the SP group (14% vs 1%, P = .001 and 11% vs 1%, P = .003).
A surveillance strategy involving VLEL led to a statistically significant higher yield of dysplasia and neoplasia detection compared with a standard random biopsy protocol. These results support the use of VLEL for surveillance in BE in academic centers.
容积激光内视镜检查（VLE）是一种用于 Barrett 食管（BE）的新型宽场高级成像技术。目前尚无关于检测异型增生的增量收益的数据。我们的目的是报告使用 VLE 检测 BE 异型增生的增量收益。
这是一项回顾性研究，来自 2011 年至 2017 年的前瞻性维护数据库，比较了学术性 BE 三级转诊中心 4 种不同监测策略的异型增生检出率。组为（1）随机活检（RB），（2）西雅图协议随机活检（SP），（3）无激光标记的 VLE（VLE）和（4）激光标记的 VLE（VLEL）。
共纳入 448 例连续患者（79 例 RB、95 例 SP、168 例 VLE 和 106 例 VLEL）符合纳入标准。在调整可见病变后，总异型增生检出率分别为 5.7%、19.6%、24.8%和 33.7%。与 SP 组相比，VLEL 组的总体异型增生检出率更高（19.6%比 33.7%，P=0.03；优势比，2.1，P=0.03）。与 SP 组相比，VLEL 和 VLE 组在肿瘤（高级别异型增生和黏膜内癌）检出率方面均有统计学差异（14%比 1%，P=0.001 和 11%比 1%，P=0.003）。
与标准随机活检方案相比，涉及 VLEL 的监测策略可显著提高异型增生和肿瘤的检出率。这些结果支持在学术中心使用 VLEL 进行 BE 监测。
