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PROBE BASED CONFOCAL ENDOMICROSCOPY MAY INCREASE DETECTION OF LOW GRADE DYSPLASIA IN MALE VETERANS PREVIOUSLY DIAGNOSED WITH NON DYSPLASTIC SHORT SEGMENT BARRETT'S ESOPHAGUS UNDERGOING SURVEILLANCE

Presentation Number: Fr223

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AuthorBlock: Karen Chang3, Nicole Shah-Ghassemzadeh1, Kenneth J. Vega2, Christian S. Jackson1
1Gastroenterology, VA Loma Linda Healthcare System, Loma Linda, California, United States; 2Augusta University, Augusta, Georgia, United States; 3University of California System, Oakland, California, United States;

Abstract Body
Intrrduction.
Probe based confocal endomicroscopy (pCLE) has allowed for increased detection of dysplastic mucosa with Barrett’s esophagus (BE). Few studies have focused on the use of pCLE in the diagnosis of dysplasia in short segment Barrett’s esophagus (SSBE). Not only is there evidence to show that standard biopsy techniques may miss dysplasia in all forms of BE, but SSBE may be missed altogether. The primary aim of our study was to determine if pCLE could be effective in diagnosing dysplastic mucosa in patients undergoing surveillance endoscopy in SSBE.
Methods
Patients diagnosed with SSBE between January 1, 2018 and January 1, 2020 at the VA Loma Linda Healthcare System (VALLHCS) were included. Esophagogastroduodenoscopy (EGD) was performed using a high defintion diagnostic upper endoscope (Olympus,Center Valley PA). All patients were undergoing BE surveillance. Patients who underwent pCLE were compared to those undergoing BE surveillance with standard biopsy protocol. All patients in the standard biopsy protocol group underwent high-defintion white light examination (HD-WLE). All pCLE examinations were performed by one gastroenterologist (C.S.J.).HD-WLE was initially performed followed by narrow band imaging and pCLE using GastroFlex UHD Confocal Miniprobe (Cellvizio, Mauna Kea Technologies). Age, sex, number of EGDs prior to a diagnosis of dysplasia, hiatal hernia length and pCLE findings were assessed. SSBE was defined using Prague criteria as follows: Barrett's circumference (C ) ≤ 2cm and maximal length of Barret't's segment (M) ≤ 3cm. Two pathologists reviewed all biopsies with a diagnosis of dysplasia. Continuous variables were compared using a Fisher’s exact test with p≤0.05 as statistically significant. This study was approved by the institutional review board for VALLHCS.
Results
Twenty-nine patients were identified as having SSBE. The mean age of the of patients undergoing pCLE was 70 years of age as well as the mean age of patients who underwent standard biopsy. All patients included were male. Mean Prague Criteria for pCLE was C1, M2.25 and the mean for standard biopsy was C.4, M1.8. The mean hiatal hernia length for pCLE patients was 3.6cm while mean hiatal hernia length for standard patients was 3.5cm. The mean number of EGDs performed prior to diagnosis of LGD in pCLE group was 3 versus 2.25 in the standard biopsy protocol group. Low-grade dysplasia was detected in 86% (6/7) of the patients who underwent pCLE versus 31% (4/22) patients with standard biopsy protocol, p=0.026.

Conclusion
In a primarily male veteran population, pCLE may be helpful in identifying low grade dysplasia in patients with SSBE that standard biopsy techniques may miss during BE surveillance.