Three-dimensional endoscopic optical coherence tomography imaging of cervical inlet patch

Abstract

A 30-year-old white man with established Barrett’s esophagus (BE) and continued symptoms of chronic severe heartburn, persistent cough, throat irritation, and asthma was referred for surveillance EGD at the VA Boston Healthcare System. During retraction of the endoscope, a pink circular lesion (A) was observed under white light endoscopy in the upper esophagus (spanning 20–22 cm from the incisors). Three-dimensional endoscopic optical coherence tomography (OCT) images were obtained of the region under direct visualization with white light by passing the probe through the standard accessory channel. An en face projection image (B) at 400-μm depth underneath the tissue surface showed columnar epithelium consistent with a cervical inlet patch (CIP) and surrounding normal squamous epithelium (SE). Cross-sectional OCT images along the probe pull-back direction (C) and the probe rotation direction (D and F) clearly demonstrated columnar and squamous epithelium in the CIP region and the surrounding esophagus, respectively. Biopsy specimens taken from the imaged lesion confirmed the finding of CIP. The OCT features matched representative hematoxylin and eosin histology (E and G). Both esophageal and extraesophageal symptoms responded to increased antacid therapy.