Ultrahigh-speed endoscopic optical coherence tomography and angiography enables delineation of lateral margins of endoscopic mucosal resection: a case report

Abstract

Endoscopic mucosal resection (EMR) is a common technique for resecting dysplastic lesions in Barrett’s esophagus (BE), stomach, and colon, but precise delineation of dysplastic margins before resection and verification of complete removal after resection remain challenging. Endoscopic optical coherence tomography (OCT) enables three-dimensional visualization of tissue microstructure and is commercially available as Volumetric Laser Endomicroscopy (NinePoint Medical, Bedford, MA, USA). We recently developed an ultrahigh-speed endoscopic OCT system which operates more than 10 times faster than commercial instruments, generating volumetric images with higher transverse resolution and voxel density. This allows visualization of depth-resolved en face mucosal and microvascular patterns (OCT angiography [OCTA]), in addition to cross-sections. A recent study with 32 patients reported 94% sensitivity and 69% specificity for identifying dysplasia on blinded assessment of OCTA images. This current report demonstrates the clinical utility of probe-based, ultrahigh-speed endoscopic OCT and OCTA for assessing a dysplastic lesion at the gastroesophageal junction (GEJ), its lateral margins before and immediately after EMR, and at 2-month follow up.