New Method: Experimental Endoscopy
Comprehensive esophageal microscopy by using optical frequency–domain imaging (with video)

https://doi.org/10.1016/j.gie.2006.08.009Get rights and content

Background

Optical coherence tomography (OCT) has been used for high-resolution endoscopic imaging and diagnosis of specialized intestinal metaplasia, dysplasia, and intramucosal carcinoma of the esophagus. However, the relatively slow image-acquisition rate of the present OCT systems inhibits wide-field imaging and limits the clinical utility of OCT for diagnostic imaging in patients with Barrett's esophagus.

Objective

This study describes a new optical imaging technology, optical frequency-domain imaging (OFDI), derived from OCT, that enables comprehensive imaging of large esophageal segments with microscopic resolution.

Design

A prototype OFDI system was developed for endoscopic imaging. The system was used in combination with a balloon-centering catheter to comprehensively image the distal esophagus in swine.

Results

Volumetric images of the mucosa and portions of the muscularis propria were obtained for 4.5-cm-long segments. Image resolution was 7 μm in depth and 30 μm parallel to the lumen, and provided clear delineation of each mucosal layer. The 3-dimensional data sets were used to create cross-sectional microscopic images, as well as vascular maps of the esophagus. Submucosal vessels and capillaries were visualized by using Doppler-flow processing.

Conclusions

Comprehensive microscopic imaging of the distal esophagus in vivo by using OFDI is feasible. The unique capabilities of this technology for obtaining detailed information of tissue microstructure over large mucosal areas may open up new possibilities for improving the management of patients with Barrett's esophagus.

Section snippets

OFDI system

The technologic approach to OFDI was previously described in detail.13 Briefly, OFDI uses a focused, narrow-diameter beam and measures the delay of reflections emanating from within the tissue sample. By repeatedly measuring these depth scans (A-lines) while the beam is scanned across the tissue, cross-sectional images are acquired. Because the propagation velocity of light in tissue is so high, the delay intervals for reflected light are too brief to be measured directly with electronic

Distal esophagus

Imaging was performed without complications in both swine. A 3-dimensional reconstruction of a helical data set at the distal esophagus is depicted in Figure 3A. The locations of the cross-sectional and longitudinal images displayed in Figures 3B and C, respectively, are shown in Figure 3A. The transverse cross-sectional image in Figure 3B shows clear delineation of the mucosal microscopic structure. Note that imaging of the entire mucosal thickness was achieved over the full 360°. A

Discussion

In this pilot study, comprehensive esophageal microscopy in vivo has been demonstrated for the first time by using a prototype OFDI system. High-resolution images were obtained from the distal esophagus and the gastroesophageal junction, which permitted clear visualization of the anatomic layers of the esophagus and of the vascular network of the muscularis mucosa. Procedure times were less than 6 minutes, but the image acquisition speed of the prototype system was limited entirely by the rate

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This research was supported, in part, by the National Institutes of Health, contracts R01 CA103769, R33 CA110130, and R01 RR0119768.

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