Читать книгу The Esophagus - Группа авторов - Страница 208

Volumetric laser endomicroscopy (VLE) uses second‐generation optical coherence tomography (OCT) technology (NvisionVLE, Merit Medical Systems, South Jordan, Utah, USA), a relatively new imaging modality that provides real‐time wide‐field endomicroscopy over the entire circumference of 6 cm of the esophagus in 90 seconds. The resolution up to 7 μm can reach a depth of 3 mm and allows for detailed microscopic imaging of the mucosa and submucosa. Unlike CLE, where microscopic intracellular detail is observed, VLE provides more detailed patterns for squamous epithelium, BE, and neoplasia. VLE allows for placement of superficial mucosal laser marks in abnormal areas that are identified, and thus targeted sampling or mucosal resection, as shown in Figures 7.1–7.3. The addition of this laser marking to the technology has been associated with increased dysplasia yield [16, 17]. Criteria for dysplasia detection in VLE have been developed in ex vivo; models and are currently used in practice for dysplasia detection [18]. New to VLE is artificial intelligence image enhancement software that can color‐code the VLE abnormalities associated with dysplasia to help the endoscopist identify abnormal areas to be subsequently laser marked [19]. The software color‐codes a hyper‐reflexive surface pink, hypo‐reflective structures or glands blue, and layering or effacement orange. Given the large amount of information obtained in a VLE scan, a computer‐aided detection model for VLE [20, 21] is most likely to be the future of this technology.