Optical Biopsy With Probe-Based Confocal Laser Endomicroscopy for Prediction of Residual Barrett’s After Complete Radiofrequency Ablation (RFA): A Pilot Study: 1945

Introduction: Radiofrequency ablation (RFA) of Barrett’s is associated with a high rate of complete eradication and a reduced risk of disease progression. Nevertheless, recent data indicate that about one third of patients had disease recurrence after reaching complete remission. We aim to evaluate whether probe-based confocal laser endomicroscopy (pCLE) can detect residual Barrett’s after complete RFA for optimized diagnosis and subsequent therapy. Methods: Consecutive patients undergoing RFA for treatment of Barrett’s were prospectively included. pCLE was performed after complete remission (CR) of dysplasia (CRD) or intestinal metaplasia (CRIM) was reached. CR was defined as complete eradication of Barrett’s as documented by white-light endoscopy and mucosal biopsies. Recurrence was defined as the presence of IM or dysplasia in optical or standard surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings.Table 1Table 2: Comparison of Findings Between pCLE and HistopathologyResults: Based on histopathological analysis, 33% of patients (3/9) had high-grade dysplasia or esophageal adenocarcinoma and 67% (6/9) had low-grade dysplasia. Radiofrequency ablation (RFA) was successfully performed in all patients (median age 60 ± 10 yrs.). Three (33%) patients underwent EMR followed by RFA. Patients received a median of 3 ± 0.6 treatment sessions of RFA after which EGD with biopsies and pCLE were performed. pCLE documented CRD and CRIM in 78% and 44 % of patients, while histology did in 90% and 67% respectively. Conclusion: pCLE is reliable for in vivo diagnosis of residual Barrett’s after complete RFA in real time and has therefore the potential to optimize diagnosis and subsequent therapy of patients. Larger, prospective studies are now highly warranted to further proof this initial concept.