Three-dimensional optical coherence tomography of Barrett’s esophagus and buried glands beneath neosquamous epithelium following radiofrequency ablation

Abstract

Ablative therapies including photodynamic therapy, argon plasma coagulation, and radiofrequency ablation (RFA) are increasingly performed for Barrett’s esophagus. Residual Barrett’s esophagus from incomplete ablation and buried Barrett’s esophagus glands beneath regenerative neosquamous epithelium are often found, to varying degrees, on follow-up [ 1 ]. While neosquamous epithelium indicates successful therapy, detection of residual disease is important for guiding additional treatments. Due to their diminutive or subsurface nature, detection of residual Barrett’s esophagus, buried glands, and neosquamous epithelium can be challenging using conventional endoscopy alone [ 1 ]. Optical coherence tomography (OCT) generates cross-sectional images of internal structure with micrometer resolutions and millimeter imaging depths by measuring the echo time delays of back-scattered light [ 2 ]. OCT can be performed with fiberoptic probes introduced through the accessory channel of standard endoscopes. Recently, endoscopic three-dimensional (3D) OCT has become possible due to dramatic increases in imaging speed [ 3 ] [ 4 ], providing an endoscopic microscopy tool with a powerful combination of high resolution, large field of view, and rapid data acquisition. Two-dimensional OCT has been extensively studied in Barrett’s esophagus, including the detection of specialized intestinal metaplasia, dysplasia, and adenocarcinoma [ 5 ] [ 6 ]. 3D-OCT has recently been used in pilot studies for esophageal [ 3 ] and colon imaging [ 4 ]. Here we report 3D-OCT findings of Barrett’s esophagus, buried Barrett’s esophagus glands beneath neosquamous epithelium following RFA, and normal squamous mucosa.