Volumetric laser endomicroscopy for the detection of early Barrett’s neoplasia

Patients with Barrett’s esophagus, in which the normal lining of the esophageal wall has been replaced under influence of chronic acid reflux, have an increased risk of developing esophageal adenocarcinoma. Barrett’s patients therefore undergo regular endoscopic surveillance. When esophageal cancer is detected in an early stage it can be treated endoscopically with an excellent prognosis. However, early cancer has a subtle appearance and can therefore be missed.
The focus of this thesis was to investigate if the advanced imaging system Volumetric laser endomicroscopy (VLE) could improve the detection of early esophageal adenocarcinoma. VLE performs a three-dimensional high-resolution scan of the entire circumference of the esophagus, with a length of 6 cm and up to a depth of 3 mm. Therefore, VLE could potentially improve the visualization of early Barrett’s cancer, which is subtly or invisible at the surface. A VLE scan comprises a large amount of data in subtle gray-shades. To know what the structures on VLE represent, we constructed a database of VLE images one-to-one correlated with the histology (gold standard). We identified VLE features of early esophageal cancer and developed a prediction score. Since interpretation of VLE seems complex even for experts, we developed a computer algorithm that showed very promising results in detecting early cancer on VLE.
In this thesis a robust basis was laid for ongoing VLE research. Future studies should focus on the diagnostic accuracy of VLE for the detection of Barrett’s cancer. An approach using both qualitative and quantitative assessments of VLE should be pursued.