Improved Barrett's neoplasia detection using computer-assisted multiframe analysis of volumetric laser endomicroscopy.

Volumetric laser endomicroscopy (VLE) is a balloon-based technique, which provides a circumferential near-microscopic scan of the esophageal wall layers, and has potential to improve Barrett's neoplasia detection. Interpretation of VLE imagery in Barrett's esophagus (BE) however is time-consuming and complex, due to a large amount of visual information and numerous subtle gray-shaded VLE images. Computer-aided detection (CAD), analyzing multiple neighboring VLE frames, might improve BE neoplasia detection compared to automated single-frame analyses. This study is to evaluate feasibility of automatic data extraction followed by CAD using a multiframe approach for detection of BE neoplasia. Prospectively collected ex-vivo VLE images from 29 BE-patients with and without early neoplasia were retrospectively analyzed. Sixty histopathology-correlated regions of interest (30 nondysplastic vs. 30 neoplastic) were assessed using different CAD systems. Multiple neighboring VLE frames, corresponding to 1.25 millimeter proximal and distal to each region of interest, were evaluated. In total, 3060 VLE frames were analyzed via the CAD multiframe analysis. Multiframe analysis resulted in a significantly higher median AUC (median level = 0.91) compared to single-frame (median level = 0.83) with a median difference of 0.08 (95% CI, 0.06-0.10), P < 0.001. A maximum AUC of 0.94 was reached when including 22 frames on each side using a multiframe approach. In total, 3060 VLE frames were automatically extracted and analyzed by CAD in 3.9 seconds. Multiframe VLE image analysis shows improved BE neoplasia detection compared to single-frame analysis. CAD with multiframe analysis allows for fast and accurate VLE interpretation, thereby showing feasibility of automatic full scan assessment in a real-time setting during endoscopy.

Volumetric laser endomicroscopy in Barrett's esophagus: a feasibility study on histological correlation.

Volumetric laser endomicroscopy (VLE) is a novel balloon-based optical coherence tomography (OCT) imaging technique that may improve detection of early neoplasia in Barrett's esophagus (BE). Most OCT studies lack a direct correlation between histology and OCT images. The aim is to investigate the optimal approach for achieving one-to-one correlation of ex-vivo VLE images of endoscopic resection (ER) specimens with histology. BE patients with and without early neoplasia underwent ER after delineating areas with electrocoagulation markers (ECM). After ER, specimens underwent additional ex-vivo marking with several different markers (ink, pin, Gold Probe) followed by ex-vivo VLE scanning. ER specimens were carefully sectioned into tissue blocks guided by the markers. Histology and VLE slides were considered a match if ≥ 2 markers were visible on both modalities and mucosal patterns aside from these markers matched on both histology and VLE. From 16 ER specimens 120 tissue blocks were sectioned of which 23 contained multiple markers. Fourteen histology-VLE matches were identified. ECMs and ink markers proved to be the most effective combination for matching. The last 6/16 ER specimens yielded 9/14 matches, demonstrating a learning curve due to methodological improvements in marker placement and tissue block sectioning. One-to-one correlation of VLE and histology is complex but feasible. The groundwork laid in this study will provide high-quality histology-VLE correlations that will allow further research on VLE features of early neoplasia in BE.

Diagnosis by endoscopy and advanced imaging.

Evaluation of patients with Barrett's oesophagus (BO) using dye-based chromoendoscopy, optical chromoendoscopy, autofluorescence imaging, or confocal laser endomicroscopy does not significantly increase the number of patients with a diagnosis of early neoplasia compared with high-definition white light endoscopy (HD-WLE) with random biopsy analysis. These newer imaging techniques are not more effective in standard surveillance of patients with BO because the prevalence of early neoplasia is low and HD-WLE with random biopsy analysis detects most cases of neoplasia. The evaluation and treatment of patients with BO and early-stage neoplasia should be centralized in tertiary referral centers, where procedures are performed under optimal conditions, by expert endoscopists. Lesions that require resection are almost always detected by HD-WLE, although advanced imaging techniques can detect additional flat lesions. However, these are of limited clinical significance because they are effectively eradicated by ablation therapy. No endoscopic imaging technique can reliably assess submucosal or lymphangio-invasion. Endoscopic resection of early-stage neoplasia in patients with BO is important for staging and management. Optical chromoendoscopy can also be used to evaluate lesions before endoscopic resection and in follow-up after successful ablation therapy.

Paediatric heart transplantation in Australia comes of age: 21 years of experience in a national centre.

BACKGROUND: Heart transplantation (HT) is established therapy for end-stage heart failure in children with cardiomyopathy or congenital heart disease. AIMS: This review summarises experience at a national referral centre since the first local transplant. METHODS: Medical records of children referred for HT between 1 April 1988 and 1 January 2010 were retrospectively reviewed. All patients listed for HT were included. Survival analysis was used to summarise wait-list time to death/transplant, and separately, time to death in HT patients. RESULTS: One hundred and thirty-nine children were accepted on to the HT waiting list during the study (median age 7.7 (interquartile range (IQR) 2.5, 13.6) years), of whom 93 underwent HT (median age 10.9 (IQR 4.4, 14.6) years). Wait-list mortality was 32% (45 of 139 patients), lowest among children aged >10 years at listing (P < 0.001). Median time to HT was 69 days (range 29-146). Survival post-transplantation was 90% (95% confidence interval 82-95) at 1 year, 82% (72-89%) at 5 years and 68% (50-80%) at 10 years. Increasing case complexity over the study period included pre- and post-transplant circulatory support, management of pulmonary hypertension and introduction of ABO-incompatible HT for infants. Post-transplant survival did not vary according to age, pre-transplant diagnosis or use of pre-transplant circulatory support (all P > 0.05). CONCLUSIONS: Results of paediatric HT in Australia are comparable with international results, despite limitations of geographic isolation, small population and low organ donation rate. Increasing case complexity has not impacted on post-transplant survival.