title: Structural markers observed with endoscopic 3-dimensional optical coherence tomography correlating with Barrett's esophagus radiofrequency ablation treatment response (with videos).
abstract: BACKGROUND
  Radiofrequency ablation (RFA) is effective for treating Barrett's esophagus (BE) but often involves multiple endoscopy sessions over several months to achieve complete response.
  
  
  OBJECTIVE
  Identify structural markers that correlate with treatment response by using 3-dimensional (3-D) optical coherence tomography (OCT; 3-D OCT).
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Single teaching hospital.
  
  
  METHODS
  Thirty-three patients, 32 male and 1 female, with short-segment (<3 cm) BE undergoing RFA treatment.
  
  
  METHODS
  Patients were treated with focal RFA, and 3-D OCT was performed at the gastroesophageal junction before and immediately after the RFA treatment. Patients were re-examined with standard endoscopy 6 to 8 weeks later and had biopsies to rule out BE if not visibly evident.
  
  
  METHODS
  The thickness of BE epithelium before RFA and the presence of residual gland-like structures immediately after RFA were determined by using 3-D OCT. The presence of BE at follow-up was assessed endoscopically.
  
  
  RESULTS
  BE mucosa was significantly thinner in patients who achieved complete eradication of intestinal metaplasia than in patients who did not achieve complete eradication of intestinal metaplasia at follow-up (257 ± 60 μm vs 403 ± 86 μm; P < .0001). A threshold thickness of 333 μm derived from receiver operating characteristic curves corresponded to a 92.3% sensitivity, 85% specificity, and 87.9% accuracy in predicting the presence of BE at follow-up. The presence of OCT-visible glands immediately after RFA also correlated with the presence of residual BE at follow-up (83.3% sensitivity, 95% specificity, 90.6% accuracy).
  
  
  CONCLUSIONS
  Single center, cross-sectional study in which only patients with short-segment BE were examined.
  
  
  CONCLUSIONS
  Three-dimensional OCT assessment of BE thickness and residual glands during RFA sessions correlated with treatment response. Three-dimensional OCT may predict responses to RFA or aid in making real-time RFA retreatment decisions in the future.
authors: Department of Electrical Engineering & Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
authors: Tsung-Han
authors: TH
authors: Tsai
authors: Chao
authors: C
authors: Zhou
authors: Yuankai K
authors: YK
authors: Tao
authors: Hsiang-Chieh
authors: HC
authors: Lee
authors: Osman O
authors: OO
authors: Ahsen
authors: Marisa
authors: M
authors: Figueiredo
authors: Tejas
authors: T
authors: Kirtane
authors: Desmond C
authors: DC
authors: Adler
authors: Joseph M
authors: JM
authors: Schmitt
authors: Qin
authors: Q
authors: Huang
authors: James G
authors: JG
authors: Fujimoto
authors: Hiroshi
authors: H
authors: Mashimo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation; D003430:Cross-Sectional Studies; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome