title: Volumetric laser endomicroscopy in the management of Barrett's esophagus.
abstract: OBJECTIVE
  The incidence of esophageal adenocarcinoma is on the rise despite widespread appreciation that the precursor lesion is Barrett's esophagus. Studies have shown that some patients known to have Barrett's esophagus develop cancer despite their enrollment in conventional endoscopic surveillance programs. This highlights the need for advanced endoscopic imaging to help identify early neoplasia and prevent its progression to esophageal cancer. Recently, a wide-field, second-generation optical coherence tomography endoscopic platform called volumetric laser endomicroscopy (VLE) was cleared by the Food and Drug Administration and made commercially available for advanced imaging in Barrett's esophagus.
  
  
  RESULTS
  The current review discusses current literature on VLE imaging in Barrett's esophagus. Based on ex-vivo studies, criteria have been established for identifying Barrett's esophagus-associated neoplasia. In addition, recent studies, case series, and case reports have demonstrated that VLE is well tolerated, efficacious, and can target neoplasia.
  
  
  CONCLUSIONS
  VLE is a new advanced imaging platform for Barrett's esophagus with considerable promise to target Barrett's esophagus-associated neoplasia. The following are needed to establish VLE's clinical role: studies showing incremental yield of dysplasia detection using VLE, studies to determine VLE's in-vivo diagnostic accuracy for identifying and classifying Barrett's esophagus-associated neoplasia, and studies on the cost-efficacy of VLE.
authors.affiliation: aDivision of Gastroenterology, Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York bDivision of Gastroenterology and Hepatology, Barrett's Esophagus Unit, Mayo Clinic, Rochester, Minnesota cH.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA.
authors.forename: Arvind J
authors.initials: AJ
authors.lastname: Trindade
authors.forename: Cadman L
authors.initials: CL
authors.lastname: Leggett
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Chang
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D001471:Barrett Esophagus / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D000069916:Endoscopic Mucosal Resection / Q000191:economics / Q000295:instrumentation*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D004943:Esophagogastric Junction / Q000473:pathology*; D006801:Humans; D000069416:Intravital Microscopy / Q000191:economics / Q000295:instrumentation*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence / Q000191:economics / Q000295:instrumentation*