New method
Clinical endoscopy
High-resolution imaging in Barrett's esophagus: a novel, low-cost endoscopic microscope

https://doi.org/10.1016/j.gie.2008.05.018Get rights and content

Background

This report describes the clinical evaluation of a novel, low-cost, high-resolution endoscopic microscope for obtaining fluorescent images of the cellular morphology of the epithelium of regions of the esophagus with Barrett's metaplasia. This noninvasive point imaging system offers a method for obtaining real-time histologic information during endoscopy.

Objective

The objective of this study was to compare images taken with the fiberoptic endoscopic microscope with standard histopathologic examination.

Design

Feasibility study.

Setting

The University of Texas M.D. Anderson Cancer Center Department of Gastroenterology.

Patients, Interventions, and Main Outcome Measurements

The tissue samples studied in this report were obtained by endoscopic resection from patients with previous diagnoses of either high-grade dysplasia or esophageal adenocarcinoma.

Results

Three distinct tissue types were observed ex vivo with the endoscopic microscope: normal squamous mucosa, Barrett's metaplasia, and high-grade dysplasia. Squamous tissue was identified by bright nuclei surrounded by dark cytoplasm in an ordered pattern. Barrett's metaplasia could be identified by large glandular structures with intact nuclear polarity. High-grade dysplasia was visualized as plentiful, irregular glandular structures and loss of nuclear polarity. Standard histopathologic examination of study samples confirmed the results obtained by the endoscopic microscope.

Limitations

The endoscopic microscope probe had to be placed into direct contact with tissue.

Conclusions

It was feasible to obtain high-resolution histopathologic information using the endoscopic microscope device. Future improvement and integration with widefield endoscopic techniques will aid in improving the sensitivity of detection of dysplasia and early cancer development in the esophagus.

Section snippets

Patients

Patients who participated in this study had been previously diagnosed with either HGD or intramucosal adenocarcinoma and were scheduled for upper endoscopy with either jumbo biopsies or EMR of the affected areas. The study protocols were approved by both the Rice University Institutional Review Board and the University of Texas M.D. Anderson Cancer Center Institutional Review Board, and informed consent was obtained from each patient before the procedure. Eleven sequential patients with a

Results

Images obtained with the endoscopic microscope were compared with histopathologic interpretation of the same areas. Fluorescence images were evaluated qualitatively, noting nuclear size and density, nuclear-to-cytoplasmic ratio, glandular structure and organization, and intensity of fluorescence. Distinct patterns of fluorescence images were observed for tissues with different histopathologic diagnoses: (1) normal squamous epithelium, (2) Barrett's metaplasia/low-grade dysplasia, and (3)

Discussion

This study demonstrates the ability of an inexpensive (<$2500) system with a reusable probe to produce high-resolution images of a variety of esophageal tissue types. Such a device can easily be integrated into any standard endoscope to noninvasively yield subcellular-resolution images of the surface histologic features of a suspected lesion with the use of an appropriate fluorescent dye. Coupled with widefield imaging devices, this endoscopic microscope system should further enhance

Acknowledgments

Special appreciation is extended to Rachna Khare and Carolyn Paraguya for their expertise and assistance.

References (22)

  • B.N.J. Thomson et al.

    Oesophagectomy for early adenocarcinoma and dysplasia arising in Barrett's oesophagus

    Anz J Surg

    (2003)
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