Detecting Dysplasia With Optical Coherence Tomography

In this issue of Clinical Gastroenterology and Hepatology, Evans et al¹ present evidence that optical coherence tomography (OCT) can detect high-grade dysplasia or intramucosal carcinoma in patients with Barrett’s esophagus. OCT is one of several optical methods that have recently been used to detect dysplasia in Barrett’s esophagus, colonic polyps, and chronic ulcerative colitis. These optical methods share a common goal of being capable to detect and confirm neoplastic change in the background of a large surface area at risk for cancer. The major theoretical advantages of optical methods, as compared with random biopsy, are the potential to reduce sampling error, reduce intraobserver disagreement, and reduce the cost and risk of biopsy by eliminating unnecessary sampling of non-neoplastic tissue. These are regarded as the “holy grail” in early detection of cancer in these conditions. Although this potential has yet to be reached, the article by Evans et al makes an important contribution to the quest.