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Sun J, Sheng J, Zhang LJ. Gastrointestinal tract. TRANSPATHOLOGY 2024:281-296. [DOI: 10.1016/b978-0-323-95223-1.00005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Roberts DW, Bravo JJ, Olson JD, Hickey WF, Harris BT, Nguyen LN, Hong J, Evans LT, Fan X, Wirth D, Wilson BC, Paulsen KD. 5-Aminolevulinic Acid-Induced Fluorescence in Focal Cortical Dysplasia: Report of 3 Cases. Oper Neurosurg (Hagerstown) 2020; 16:403-414. [PMID: 29920583 DOI: 10.1093/ons/opy116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 04/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Three patients enrolled in a clinical trial of 5-aminolevulinic-acid (5-ALA)-induced fluorescence-guidance, which has been demonstrated to facilitate intracranial tumor resection, were found on neuropathological examination to have focal cortical dysplasia (FCD). OBJECTIVE To evaluate in this case series visible fluorescence and quantitative levels of protoporphyrin IX (PpIX) during surgery and correlate these findings with preoperative magnetic resonance imaging (MRI) and histopathology. METHODS Patients were administered 5-ALA (20 mg/kg) approximately 3 h prior to surgery and underwent image-guided, microsurgical resection of their MRI- and electrophysiologically identified lesions. Intraoperative visible fluorescence was evaluated using an operating microscope adapted with a commercially available blue light module. Quantitative PpIX levels were assessed using a handheld fiber-optic probe and a wide-field imaging spectrometer. Sites of fluorescence measurements were co-registered with both preoperative MRI and histopathological analysis. RESULTS Three patients with a pathologically confirmed diagnosis of FCD (Types 1b, 2a, and 2b) underwent surgery. All patients demonstrated some degree of visible fluorescence (faint or moderate), and all patients had quantitatively elevated concentrations of PpIX. No evidence of neoplasia was identified on histopathology, and in 1 patient, the highest concentrations of PpIX were found at a tissue site with marked gliosis but no typical histological features of FCD. CONCLUSION FCD has been found to be associated with intraoperative 5-ALA-induced visible fluorescence and quantitatively confirmed elevated concentrations of the fluorophore PpIX in 3 patients. This finding suggests that there may be a role for fluorescence-guidance during surgical intervention for epilepsy-associated FCD.
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Affiliation(s)
- David W Roberts
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School Medicine, Dartmouth College, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jaime J Bravo
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Jonathan D Olson
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - William F Hickey
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Brent T Harris
- Departments of Pathology and Neurology, Georgetown University Medical Center, Washington, District of Columbia
| | - Lananh N Nguyen
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jennifer Hong
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Linton T Evans
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Xiaoyao Fan
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Dennis Wirth
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Brian C Wilson
- Princess Margaret Cancer Centre, University Health Network, Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Keith D Paulsen
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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Minamikawa T, Matsuo H, Kato Y, Harada Y, Otsuji E, Yanagisawa A, Tanaka H, Takamatsu T. Simplified and optimized multispectral imaging for 5-ALA-based fluorescence diagnosis of malignant lesions. Sci Rep 2016; 6:25530. [PMID: 27149301 PMCID: PMC4857744 DOI: 10.1038/srep25530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/19/2016] [Indexed: 12/17/2022] Open
Abstract
5-aminolevulinic acid (5-ALA)-based fluorescence diagnosis is now clinically applied for accurate and ultrarapid diagnosis of malignant lesions such as lymph node metastasis during surgery. 5-ALA-based diagnosis evaluates fluorescence intensity of a fluorescent metabolite of 5-ALA, protoporphyrin IX (PPIX); however, the fluorescence of PPIX is often affected by autofluorescence of tissue chromophores, such as collagen and flavins. In this study, we demonstrated PPIX fluorescence estimation with autofluorescence elimination for 5-ALA-based fluorescence diagnosis of malignant lesions by simplified and optimized multispectral imaging. We computationally optimized observation wavelength regions for the estimation of PPIX fluorescence in terms of minimizing prediction error of PPIX fluorescence intensity in the presence of typical chromophores, collagen and flavins. By using the fluorescence intensities of the optimized wavelength regions, we verified quantitative detection of PPIX fluorescence by using chemical mixtures of PPIX, flavins, and collagen. Furthermore, we demonstrated detection capability by using metastatic and non-metastatic lymph nodes of colorectal cancer patients. These results suggest the potential and usefulness of the background-free estimation method of PPIX fluorescence for 5-ALA-based fluorescence diagnosis of malignant lesions, and we expect this method to be beneficial for intraoperative and rapid cancer diagnosis.
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Affiliation(s)
- Takeo Minamikawa
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hisataka Matsuo
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.,Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yoshiyuki Kato
- Ushio Inc., 6409 Moto-Ishikawa-cho, Aoba-ku, Yokohama, Kanagawa 225-0004, Japan
| | - Yoshinori Harada
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hideo Tanaka
- Department of Pathology and Cell Regulation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tetsuro Takamatsu
- Department of Medical Photonics, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Thekkek N, Lee MH, Polydorides AD, Rosen DG, Anandasabapathy S, Richards-Kortum R. Quantitative evaluation of in vivo vital-dye fluorescence endoscopic imaging for the detection of Barrett's-associated neoplasia. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:56002. [PMID: 25950645 PMCID: PMC4423850 DOI: 10.1117/1.jbo.20.5.056002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/20/2015] [Indexed: 05/21/2023]
Abstract
Current imaging tools are associated with inconsistent sensitivity and specificity for detection of Barrett's-associated neoplasia. Optical imaging has shown promise in improving the classification of neoplasia in vivo. The goal of this pilot study was to evaluate whether in vivo vital dye fluorescence imaging (VFI) has the potential to improve the accuracy of early-detection of Barrett's-associated neoplasia. In vivo endoscopic VFI images were collected from 65 sites in 14 patients with confirmed Barrett's esophagus (BE), dysplasia, oresophageal adenocarcinoma using a modular video endoscope and a high-resolution microendoscope(HRME). Qualitative image features were compared to histology; VFI and HRME images show changes in glandular structure associated with neoplastic progression. Quantitative image features in VFI images were identified for objective image classification of metaplasia and neoplasia, and a diagnostic algorithm was developed using leave-one-out cross validation. Three image features extracted from VFI images were used to classify tissue as neoplastic or not with a sensitivity of 87.8% and a specificity of 77.6% (AUC = 0.878). A multimodal approach incorporating VFI and HRME imaging can delineate epithelial changes present in Barrett's-associated neoplasia. Quantitative analysis of VFI images may provide a means for objective interpretation of BE during surveillance.
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Affiliation(s)
- Nadhi Thekkek
- Rice University, Department of Bioengineering, MS-142, Box 1892, Houston, Texas 77251-1892, United States
- Address all correspondence to: Nadhi Thekkek, E-mail:
| | - Michelle H. Lee
- Icahn School of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1069, New York, New York 10029-6574, United States
| | - Alexandros D. Polydorides
- Icahn School of Medicine, Mount Sinai Medical Center, Department of Pathology, One Gustave L. Levy Place, Box 1194, New York, New York 10029-6574, United States
| | - Daniel G. Rosen
- Baylor College of Medicine, Department of Pathology, One Baylor Plaza, Cullen 271A, Houston, Texas 77030, United States
| | - Sharmila Anandasabapathy
- Baylor College of Medicine, Department of Medicine, One Baylor Plaza, Cullen 271A, Houston, Texas 77030, United States
| | - Rebecca Richards-Kortum
- Rice University, Department of Bioengineering, MS-142, Box 1892, Houston, Texas 77251-1892, United States
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Hoetker MS, Goetz M. Molecular imaging in endoscopy. United European Gastroenterol J 2014; 1:84-92. [PMID: 24917945 DOI: 10.1177/2050640613483291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/18/2013] [Indexed: 02/06/2023] Open
Abstract
Molecular imaging focuses on the molecular signature of cells rather than morphological changes in the tissue. The need for this novel type of imaging arises from the often difficult detection and characterization especially of small and/or premalignant lesions. Molecular imaging specifically visualizes biological properties of a lesion and might thereby be able to close diagnostic gaps, e.g. when differentiating hyperplastic from neoplastic polyps or detecting the margins of intraepithelial neoplastic spread. Additionally, not only the detection and discrimination of lesions could be improved: based on the molecular features identified using molecular imaging, therapy regimens could be adjusted on the day of diagnosis to allow for personalized medicine and optimized care for each individual patient.
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Affiliation(s)
| | - Martin Goetz
- Universitätsklinikum Tübingen, Tübingen, Germany
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Screening for precancerous lesions of upper gastrointestinal tract: from the endoscopists' viewpoint. Gastroenterol Res Pract 2013; 2013:681439. [PMID: 23573079 PMCID: PMC3615623 DOI: 10.1155/2013/681439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 02/19/2013] [Indexed: 02/06/2023] Open
Abstract
Upper gastrointestinal tract cancers are one of the most important leading causes of cancer death worldwide. Diagnosis at late stages always brings about poor outcome of these malignancies. The early detection of precancerous or early cancerous lesions of gastrointestinal tract is therefore of utmost importance to improve the overall outcome and maintain a good quality of life of patients. The desire of endoscopists to visualize the invisibles under conventional white-light endoscopy has accelerated the advancements in endoscopy technologies. Nowadays, image-enhanced endoscopy which utilizes optical- or dye-based contrasting techniques has been widely applied in endoscopic screening program of gastrointestinal tract malignancies. These contrasting endoscopic technologies not only improve the visualization of early foci missed by conventional endoscopy, but also gain the insight of histopathology and tumor invasiveness, that is so-called optical biopsy. Here, we will review the application of advanced endoscopy technique in screening program of upper gastrointestinal tract cancers.
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Singh R, Mei SCY, Sethi S. Advanced endoscopic imaging in Barrett's oesophagus: A review on current practice. World J Gastroenterol 2011; 17:4271-6. [PMID: 22090782 PMCID: PMC3214701 DOI: 10.3748/wjg.v17.i38.4271] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/30/2011] [Accepted: 06/06/2011] [Indexed: 02/06/2023] Open
Abstract
Over the last few years, improvements in endoscopic imaging technology have enabled identification of dysplasia and early cancer in Barrett’s oesophagus. New techniques should exhibit high sensitivities and specificities and have good interobserver agreement. They should also be affordable and easily applicable to the community gastroenterologist. Ideally, these modalities must exhibit the capability of imaging wide areas in real time whilst enabling the endoscopist to specifically target abnormal areas. This review will specifically focus on some of the novel endoscopic imaging modalities currently available in routine practice which includes chromoendoscopy, autofluorescence imaging and narrow band imaging.
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Advancements in endoscopic imaging for the detection of esophageal dysplasia and carcinoma. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shahid MW, Wallace MB. Endoscopic imaging for the detection of esophageal dysplasia and carcinoma. Gastrointest Endosc Clin N Am 2010; 20:11-24, v. [PMID: 19951791 DOI: 10.1016/j.giec.2009.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous endoscopic imaging modalities have been developed and introduced into clinical practice to enhance diagnostic capabilities. In the past, detection of dysplasia and carcinoma of the esophagus has been dependent on biopsies taken during standard white-light endoscopy. Recent important developments in biophonotics have improved visualization of these subtle lesions sufficiently for cellular details to be seen in vivo during endoscopy. These improvements allow diagnosis to be made in gastrointestinal endoscopy units, thereby avoiding the cost, risk, and time delay involved in tissue biopsy and resection. Chromoendoscopy, narrow-band imaging, high-yield white-light endoscopy, Fujinon intelligent color enhancement, and point enhancement such as confocal laser endomicroscopy are examples of enhanced imaging technologies that are being used in daily practice. This article reviews endoscopic-based imaging techniques for the detection of esophageal dysplasia and carcinoma from the perspective of routine clinical practice.
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Affiliation(s)
- Muhammad W Shahid
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA
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Pedrosa MC. The hunt for dysplasia in Barrett's esophagus. Gastrointest Endosc 2009; 70:1079-81. [PMID: 19962499 DOI: 10.1016/j.gie.2009.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/23/2009] [Indexed: 01/15/2023]
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Abstract
There have been many developments in endoscopy-based imaging for the detection of Barrett's syndrome, dysplasia, and neoplasia in patients with Barrett's esophagus. This article reviews the studies on and compares the efficacy of several important endoscopic imaging modalities. Some of these technologies have already achieved regulatory approval, commercial availability, and establishment of clinical utility and practical application. The future of imaging for Barrett's syndrome likely rests with the development of molecular targeting with dysplasiatargeted probes that have been conjugated to dyes or nanoparticles.
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Anastassiades CP, Wilson BC, Wong Kee Song LM. Fluorescence and Raman spectroscopy. Gastrointest Endosc Clin N Am 2009; 19:221-31. [PMID: 19423020 DOI: 10.1016/j.giec.2009.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reflectance spectroscopy is an emerging technology which provides rapid and safe evaluation of tissue for dysplasia and ischemia. The probe-based devices can be passed through most endoscopes. Current applications include detection of dysplasia in Barrett's esophagus, colitis, and colon polyps.
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Abstract
Delta-aminolevulinic acid/protoporphyrin IX is applied for fluorescent tumor detection in the upper part of gastrointestinal tract. The 5-ALA is administered per os six hours before measurements at dose 20 mg/kg weight. High-power light-emitting diode at 405 nm is used as an excitation source. Special opto-mechanical device is built to use the light guide of standard video-endoscopic system. Through endoscopic instrumental channel a fiber is applied to return information about fluorescence to microspectrometer. In such way, 1D detection and 2D visualization of the lesions' fluorescence are received, and both advantages and limitations of these methodologies are discussed in relation to their clinical applicability. Comparison of the spectra received from normal mucosa, inflammatory, and tumor areas is applied to evaluate the feasibility for development of simple but effective algorithm based on dimensionless ratio of the fluorescence signals at 560 and 635 nm, for differentiation of normal/abnormal gastrointestinal tissues.
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Curvers WL, Kiesslich R, Bergman JJGHM. Novel imaging modalities in the detection of oesophageal neoplasia. Best Pract Res Clin Gastroenterol 2008; 22:687-720. [PMID: 18656825 DOI: 10.1016/j.bpg.2008.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prognosis of oesophageal neoplasia is dependent on the stage of the disease at the time of detection. Early lesions have an excellent prognosis in contrast to more advanced stages that usually have a dismal prognosis. Therefore, the early detection of these lesions is of the utmost importance. In recent years, several new techniques have been introduced to improve the endoscopic detection of early lesions. The most important improvement, in general, has been the introduction of high-resolution/high-definition endoscopy into daily clinical practice. The value of superimposing techniques such as chromoendoscopy, narrow band imaging and computed virtual chromoendoscopy onto high-resolution/high-definition endoscopy will have to be proven in randomised cross-over trials comparing these techniques with standard techniques. Important future adjuncts to white-light endoscopy serving as 'red-flag' techniques for the detection of early neoplasia may be broad field functional imaging techniques such as video autofluorescence endoscopy. In addition, real-time histopathology during endoscopy has become possible with endocytoscopy and confocal endomicroscopy. The clinical value of these techniques needs to be ascertained in the coming years.
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Affiliation(s)
- W L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
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Singh R, Ragunath K, Jankowski J. Barrett's Esophagus: Diagnosis, Screening, Surveillance, and Controversies. Gut Liver 2007; 1:93-100. [PMID: 20485625 PMCID: PMC2871632 DOI: 10.5009/gnl.2007.1.2.93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/05/2007] [Indexed: 12/20/2022] Open
Abstract
Barrett's esophagus (BE) is a frequent complication of gastroesophageal reflux disease, an acquired condition resulting from persistent mucosal injury to the esophagus. The incidence of Barrett's metaplasia and Barrett's adenocarcinoma has been increasing, but the prognosis of Barrett's adenocarcinoma is worse because individuals present at a late stage. Attempts have been made to intervene at early stage using surveillance programmes, although proof of efficacy of endoscopic surveillance is lacking. There is much to be learned about BE. Whether adequate control of gastroesophageal reflux early in the disease alters the natural history of Barrett's change once it has developed remains unanswered. Thus there is great need for carefully designed large randomised controlled trials to address these issues in order to determine how best to manage patients with BE. The AspECT and BOSS clinical trials proride this basis.
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Affiliation(s)
- Rajvinder Singh
- Wolfson Digestive Diseases Centre, University Hospital Nottingham, UK
| | - Krish Ragunath
- Wolfson Digestive Diseases Centre, University Hospital Nottingham, UK
| | - Janusz Jankowski
- UHL Trust and Department of Clinical Pharmacology, University of Oxford, UK
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Vázquez-Iglesias JL, Alonso-Aguirre P, Diz-Lois MT, Vázquez-Millán MA, Alvarez A, Lorenzo MJ. Acetic acid allows effective selection of areas for obtaining biopsy samples in Barrett's esophagus. Eur J Gastroenterol Hepatol 2007; 19:187-93. [PMID: 17301644 DOI: 10.1097/meg.0b013e3280102f5e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether macroscopic changes resulting from acetic acid application on the surface of columnar-lined esophagus allow regular, nonmagnifying, endoscopic identification of areas presenting dysplasia and/or cancer in Barrett's esophagus. PATIENTS AND METHODS A total of 100 patients (mean age, 53 years; range, 27-86 years) under surveillance because of short-segment (n=71) and long-segment (n=29) Barrett's esophagus, with no alterations of columnar-lined esophagus on standard endoscopy, were enrolled. After endoscopic examination, 3% acetic acid was sprayed on columnar-lined esophagus. The subsequent appearance of the mucosa was classified as: (1) Normal pattern: uniform reticulum along the entire columnar-lined esophagus. (2) Abnormal pattern: reticulum presenting areas of rough or irregular appearance. Biopsy samples were obtained from areas of normal and abnormal patterns, and the results of the corresponding histological studies were compared. All endoscopies were performed by the same investigator. RESULTS The endoscopic appearance, after acetic acid application, corresponded to a normal pattern in 85% of cases and an abnormal pattern in 15%. The percentage of dysplasia and adenocarcinoma in biopsy specimens was significantly higher in patients with rough or irregular areas (86.7%) than in those with normal uniform reticulum (0%) (P< 0.001). Sensitivity for the identification of areas of dysplasia or adenocarcinoma was 100% (95% confidence interval: 71.7-100%). Specificity was 97.7% (95% confidence interval: 91.2-99.6%). CONCLUSIONS This prospective study shows that acetic acid test is useful for standard, nonmagnifying, endoscopic detection of dysplasia and cancer in Barrett's esophagus.
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Qi X, Sivak MV, Isenberg G, Willis JE, Rollins AM. Computer-aided diagnosis of dysplasia in Barrett's esophagus using endoscopic optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2006; 11:044010. [PMID: 16965167 DOI: 10.1117/1.2337314] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Barrett's esophagus (BE) and associated adenocarcinoma have emerged as a major health care problem over the last two decades. Because of the widespread use of endoscopy, BE is being recognized increasingly in all Western countries. In clinical trials of endoscopic optical coherence tomography (EOCT), we defined certain image features that appear to be characteristic of precancerous (dysplastic) mucosa: decreased scattering and disorganization in the microscopic morphology. The objective of the present work is to develop computer-aided diagnosis (CAD) algorithms that aid the detection of dysplasia in BE. The image dataset used in the present study was derived from a total of 405 EOCT images (13 patients) that were paired with highly correlated histologic sections of corresponding biopsies. Of these, 106 images were included in the study. The CAD algorithm used was based on a standard texture analysis method (center-symmetric auto-correlation). Using histology as the reference standard, this CAD algorithm had a sensitivity of 82%, specificity of 74%, and accuracy of 83%. CAD has the potential to quantify and standardize the diagnosis of dysplasia and allows high throughput image evaluation for EOCT screening applications. With further refinements, CAD could also improve the accuracy of EOCT identification of dysplasia in BE.
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Affiliation(s)
- Xin Qi
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
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Poneros J. Optical coherence tomography and the detection of dysplasia in Barrett's esophagus. Gastrointest Endosc 2005; 62:832-3. [PMID: 16301021 DOI: 10.1016/j.gie.2005.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 07/13/2005] [Indexed: 12/20/2022]
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Pellisé M, Llach J, Bordas JM. Técnicas endoscópicas emergentes. La llegada de la histología virtual. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:641-8. [PMID: 16373017 DOI: 10.1016/s0210-5705(05)71531-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endoscopic technology has evolved in such a way that gastroenterologists can now visualize and store high-resolution images of the gastrointestinal tract. This has improved the approach to precancerous and cancerous lesions of the gastrointestinal tract and biliary tree. However, certain difficulties remain, especially in relation to diagnosis. In the last few years, multiple techniques have been developed that, using the properties of light, enable an instantaneous histologic diagnosis to be made while endoscopy is being performed. What has been called the "optical biopsy" allows highly exact information to be obtained, both from the morphological and functional point of view. Some of these techniques, such as chromoendoscopy and magnification, are already being performed in clinical practice while others are still under investigation. The aim of the present article is to review the underlying principles and applications of these emerging techniques.
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Affiliation(s)
- M Pellisé
- Servicio de Gastroenterología, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, Spain.
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Abstract
The detection of early-stage neoplastic lesions in the upper GI tract is associated with improved survival and the potential for complete endoscopic resection that is minimally invasive and less morbid than surgery. Despite technological advances in standard white-light endoscopy, the ability of the endoscopist to reliably detect dysplastic and early cancerous changes in the upper GI tract remains limited. In conditions such as Barrett's oesophagus, practice guidelines recommend periodic endoscopic surveillance with multiple biopsies, a methodology that is hindered by random sampling error, inconsistent histopathological interpretation, and delay in diagnosis. Early detection may be enhanced by several promising diagnostic modalities such as chromoendoscopy, magnification endoscopy, and optical spectroscopic/imaging techniques, as these modalities offer the potential to identify in real-time lesions that are inconspicuous under conventional endoscopy. The combination of novel diagnostic techniques and local endoscopic therapies will provide the endoscopist with much needed tools that can considerably enhance the detection and management of early stage lesions in the upper GI tract.
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Affiliation(s)
- Louis-Michel Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, USA.
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Zöpf T, Schneider ARJ, Weickert U, Riemann JF, Arnold JC. Improved preoperative tumor staging by 5-aminolevulinic acid induced fluorescence laparoscopy. Gastrointest Endosc 2005; 62:763-7. [PMID: 16246693 DOI: 10.1016/j.gie.2005.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 05/12/2005] [Indexed: 01/04/2023]
Abstract
BACKGROUND We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases the yield of metastatic lesions and alters treatment intervention. METHODS Fluorescence laparoscopy was successfully performed in 30 patients with GI malignancies. After sensitization with 5-aminolevulinic acid, conventional white-light mode and fluorescence-light laparoscopies were sequentially performed. A suspected malignancy was biopsied. OBSERVATIONS In 5 patients, examinations were incomplete because of adhesions. In 9 of 10 patients, hepatic or peritoneal metastases were detected by white-light examination. In 4 of these 9, blue-light examination yielded more metastatic lesions. In one patient with no lesions by white- or blue-light examination, surgery revealed hepatic metastasis in a location not accessible to laparoscopic examination. In 18 patients, surgery confirmed the absence of metastatic lesions. CONCLUSIONS A fluorescence, blue-light examination yielded more lesions than the conventional white-light examination but did not alter treatment intervention and did not enhance yield when metastatic lesion is in an inaccessible location. Continued research should focus on whether treatment intervention will be altered by the fluorescence examination.
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Affiliation(s)
- Thomas Zöpf
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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23
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Abstract
Gastrointestinal (GI) tract malignancies have a tremendous impact on society. Colorectal cancer is the second leading cause of cancer death in the United States and accounts for 10% of all cancer deaths. Significant research efforts are being directed toward using the interaction of light and tissue to detect pre-cancerous lesions of the GI tract. This article reviews the current status of various experimental optical technologies to detect pre-cancerous changes in the GI tract and focuses on the clinical applications of these technologies for the practicing gastroenterologist.
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Affiliation(s)
- Linda S Lee
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, MA 02114, USA
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24
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Abstract
Patients with Barrett's esophagus (BE) undergo periodic endoscopic surveillance with multiple biopsy examinations in an attempt to identify dysplastic and early cancerous lesions at a time when intervention can be beneficial. However, this surveillance approach is hindered by low sampling yield, random sampling error, pathology-associated costs, and delay in diagnosis. Optical spectroscopy offers the potential to identify tissue pathology accurately in real time. The technique uses diagnostic molecular and/or microstructural information contained in light-tissue interactions such as fluorescence, elastic scattering, and inelastic (Raman) scattering. As an adjunct to endoscopy, optical spectroscopy has the capacity to enhance lesion detection in premalignant conditions such as BE. This article highlights the current status and future prospects of optical spectroscopy in BE.
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Affiliation(s)
- Louis-Michel Wong Kee Song
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
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25
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Wang KK, Wongkeesong M, Buttar NS. American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology 2005; 128:1471-505. [PMID: 15887129 DOI: 10.1053/j.gastro.2005.03.077] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kenneth K Wang
- Barrett's Esophagus Unit, St. Mary's Hospital, Mayo Clinic, Rochester, Minnesota, USA
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26
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Kara MA, Smits ME, Rosmolen WD, Bultje AC, Ten Kate FJW, Fockens P, Tytgat GNJ, Bergman JJGHM. A randomized crossover study comparing light-induced fluorescence endoscopy with standard videoendoscopy for the detection of early neoplasia in Barrett's esophagus. Gastrointest Endosc 2005; 61:671-8. [PMID: 15855970 DOI: 10.1016/s0016-5107(04)02777-4] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Light-induced fluorescence endoscopy (LIFE) may improve the detection of high-grade dysplasia (HGD) and early stage cancer (EC) in Barrett's esophagus (BE). The aim of this study was to compare LIFE with standard endoscopy (SE) in a randomized crossover study. METHODS Fifty patients with BE underwent SE and LIFE in a randomized sequence (4 to 6-week interval between procedures). The two procedures were performed by two different endoscopists who were blinded to the findings of the other examination. Targeted biopsy specimens were taken from detected lesions, followed by random biopsy specimens with a 2-cm interval, 4-quadrant protocol. Biopsy specimens were routinely evaluated and subsequently reviewed by a single, blinded expert GI pathologist. RESULTS Targeted biopsy specimens had a sensitivity for the diagnosis of HGD/EC of 62% (8/13) for both techniques. The overall sensitivity (all biopsy specimens) was 85% for SE and 69% for LIFE (p = 0.69). All targeted biopsy specimens had a positive predictive value (PPV) for HGD/EC of 41% for SE and 28% for LIFE (p = 0.40); autofluorescence-targeted biopsy specimens had a PPV of 13%. False-positive lesions had a significantly higher rate of acute inflammation than random biopsy specimens. CONCLUSIONS In this study, LIFE did not improve the detection of HGD or EC in patients with BE compared with SE.
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Affiliation(s)
- Mohammed A Kara
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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27
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Wong Kee Song LM, Wilson BC. Optical Detection of High-Grade Dysplasia in Barrett’s Esophagus. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2005. [DOI: 10.1016/j.tgie.2005.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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28
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Abstract
GOALS Review recent developments in Barrett's dysplasia including regulatory approval of porfimer sodium photodynamic therapy. BACKGROUND Barrett's esophagus is thought to be the result of long-standing gastroesophageal reflux disease and is known to be the most important risk factor for the development of esophageal adenocarcinoma. The natural history of Barrett's esophagus is not well known, but the annual incidence of invasive adenocarcinoma is estimated to be 0.5% (reported range, 0.2%-2.0%). This represents an increased risk for esophageal cancer of 30 to 60 times higher than normal subjects. As for colorectal cancer, malignant degeneration is Barrett's esophagus is thought to occur through a continuum of histologic stages: metaplasia, dysplasia and neoplasia. Barrett's high-grade dysplasia (formerly referred to as carcinoma in situ) is the histologic stage of disease that immediately precedes the development of invasive carcinoma. CONCLUSIONS Previously, Barrett's high-grade dysplasia patients were routinely referred for esophageal resection surgery based upon the assumption of inevitable progression to cancer, the high rate of undiagnosed synchronous cancers, and few treatment alternatives. Important developments in Barrett's high-grade dysplasia include recent publications regarding the natural history of Barrett's high-grade dysplasia and the regulatory approval for endoscopic ablation therapy using porfimer sodium photodynamic therapy (Photofrin PDT).
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Affiliation(s)
- Herbert C Wolfsen
- Department of Medicine and Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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29
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Abstract
The new developments in the management of Barrett's esophagus in 2005 result in refinements of decision making. New techniques including magnification endoscopy have been used for real-time recognition of intestinal metaplasia but are not yet validated. The finding of BE in patients lacking GERD symptoms highlights the problems of developing screening criteria for the general population. Many experimental optical techniques are pushing the optical recognition of dysplasia to real time. Availability, cost and validation remain barriers to clinical application. Endoscopic mucosal resection is being more widely applied resulting in more accurate staging of patients with early adenocarcinoma of the esophagus and helping to define patients amenable to endoscopic therapy. The approval of photodynamic therapy for the treatment of high grade dysplasia adds to the non-operative therapeutic arsenal. The impact of medical therapy of GERD and anti-reflux surgery on the development of esophageal adenocarcinoma is disappointing. Technological developments and emerging efforts in chemoprevention offer promise for the future.
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Affiliation(s)
- R E Sampliner
- Department of Medicine, Section of Gastroenterology, Southern Arizona VA Health Care System, University of Arizona College of Medicine, 3601 S. Sixth Avenue, Tucson, AZ 85723, USA.
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30
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Sampliner RE. Epidemiology, pathophysiology, and treatment of Barrett's esophagus: reducing mortality from esophageal adenocarcinoma. Med Clin North Am 2005; 89:293-312. [PMID: 15656928 DOI: 10.1016/j.mcna.2004.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The definition of BE has evolved over time. BE is the key premalignant lesion for developing EAC. The epidemiology and pathophysiology of BE is outlined, and risk factors for BE and EAC are reviewed. GERD plays a crucial role in the pathophysiology and the clinical identification of BE. Endoscopy with biopsy is the best tool for diagnosing and surveying patients with BE. Detection of early neoplasia is the present approach to reduce EAC mortality. Novel technology should assist in the early detection of dysplasia to enable targeted therapy. Effective chemopreventive strategies may reduce the risk of progression to EAC.
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Affiliation(s)
- Richard E Sampliner
- Section of Gastroenterology, Southern Arizona Veterans Affairs Health Care System, 3601 South 6th Avenue, Tucson, AZ 85723, USA.
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31
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Sharma P. Review article: emerging techniques for screening and surveillance in Barrett's oesophagus. Aliment Pharmacol Ther 2004; 20 Suppl 5:63-70; discussion 95-6. [PMID: 15456467 DOI: 10.1111/j.1365-2036.2004.02136.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The incidence of oesophageal adenocarcinoma continues to increase in the US and the Western world, with the 5-year survival rate for this cancer still being very dismal. The diagnosis of Barrett's metaplasia and dysplasia (i.e. screening and surveillance) currently requires endoscopy with biopsy of the abnormally appearing distal oesophagus. Surveillance endoscopy in patients with Barrett's oesophagus relies on the performance of random biopsies from the metaplastic segment, with the aim of identifying dysplasia and/or cancer. However, intestinal metaplasia and dysplasia are not uniformly distributed within the columnar-lined mucosa in the distal oesophagus, and the sensitivity of standard endoscopy with biopsy for the detection of these lesions is low. New techniques to improve the accuracy of endoscopic diagnosis, as well as to identify patients at high risk for neoplasia development, have recently been developed and most are currently being evaluated in clinical studies. The results with these techniques, although promising, are still preliminary. They hold promise for the improved detection of dysplasia and neoplasia at an early stage of development, with a greater chance for early treatment, and therefore a greater likelihood of either cure of adenocarcinoma or prevention of its development from dysplasia.
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Affiliation(s)
- P Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, MO 64128, USA.
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32
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Abstract
Barrett's esophagus is a precursor of adenocarcinoma of the esophagus. This cancer has the fastest growing incidence of any solid tumor in the Western world. Surveillance of Barrett's esophagus is routinely undertaken to detect early malignant transformation. However, ablative endoscopic treatments are available and these can obliterate the abnormal epithelium, allowing neosquamous regrowth. Photodynamic therapy using 5-aminolaevulinic acid (ALA) is such a technique. In this non-thermal method of ablation, ALA is metabolized to produce the photosensitizer protoprophyrin IX. This, together with light and oxygen, produces local tissue destruction. Fluorescence detection using ALA has also been used to identify areas of dysplasia and thus enhance positive biopsy yield. The use of ALA in photodynamic therapy and photodetection is reviewed.
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Affiliation(s)
- P E Claydon
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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33
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Abstract
Endoscopic diagnosis currently relies on the ability of the operator to visualize abnormal patterns in the image created by light reflected from the mucosal surface of the gastrointestinal tract. Advances in fiber optics, light sources, detectors, and molecular biology have led to the development of several novel methods for tissue evaluation in situ. The term "optical biopsy" refers to methods that use the properties of light to enable the operator to make an instant diagnosis at endoscopy, previously possible only by using histological or cytological analysis. Promising imaging techniques include fluorescence endoscopy, optical coherence tomography, confocal microendoscopy, and molecular imaging. Point detection schemes under development include light scattering and Raman spectroscopy. Such advanced diagnostic methods go beyond standard endoscopic techniques by offering improved image resolution, contrast, and tissue penetration and providing biochemical and molecular information about mucosal disease. This review describes the basic biophysics of light-tissue interactions, assesses the strengths and weaknesses of each method, and examines clinical and preclinical evidence for each approach.
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Affiliation(s)
- Thomas D Wang
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94305, USA
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34
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Georgakoudi I, Feld MS. The combined use of fluorescence, reflectance, and light-scattering spectroscopy for evaluating dysplasia in Barrett's esophagus. Gastrointest Endosc Clin N Am 2004; 14:519-37, ix. [PMID: 15261200 DOI: 10.1016/j.giec.2004.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intrinsic fluorescence, diffuse reflectance, and light-scattering spectroscopy provide complementary information on biochemical and morphologic information extending potentially from the molecular to the tissue level. Model-based spectral analysis in each case yields results about specific tissue parameters in a quantitative manner.Preliminary studies demonstrate that these parameters can be used for the development of algorithms that can detect dysplastic changes in patients with Barrett's esophagus (BE) with high sensitivity and specificity. Studies validating tri-modal spectroscopy based algorithms and real-time spectroscopic data analysis are under way to provide a more accurate and extensive assessment of the potential of this approach as a clinical noninvasive tool that could improve the management and treatment of BE dysplasia.
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Affiliation(s)
- Irene Georgakoudi
- Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, 40 Blossom Street, Boston, MA 02114, USA.
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35
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Endlicher E, Messmann H. Photodynamic diagnosis in the gastrointestinal tract. Gastrointest Endosc Clin N Am 2004; 14:475-85, viii. [PMID: 15261197 DOI: 10.1016/j.giec.2004.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Clinical data on photodynamic diagnosis for the detection of premalignant and malignant lesions in the gastrointestinal tract are encouraging so far. A major benefit of using autofluorescence is the lack of side effects because no sensitizer has to be applied.However, highly sophisticated detection systems are needed to enhance the weak autofluorescence-based fluorescent signal. New prototypes of autofluorescence video endoscopes are under way and will be decisive for further clinical use, especially because results of recently published studies have been disappointing.
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Affiliation(s)
- Esther Endlicher
- Department of Internal Medicine I, University of Regensburg, 03042 Regensburg, Germany
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36
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Abstract
PURPOSE OF REVIEW Technology for detection and staging of esophageal cancer has made significant strides advances in the past 2 years. These advances have led to the enhanced selection of appropriate treatments for esophageal cancer. Cancers that are discovered at an early stage can be treated with endoscopic therapy, whereas advanced cancers are primarily treated with chemotherapy and radiation. RECENT FINDINGS Detection of esophageal cancer can be enhanced by two major mechanisms: one is by enhancing the lesion, which has typically been done using vital dyes and the other is by changing the method of imaging of the lesion, which has been accomplished by the use of several technologies including fluorescence and optical coherence tomography. Neither of these techniques has been proven, but some investigators have been able to use them to enhance cancer detection. Similar technologies have been applied to staging esophageal cancer. The optical imaging devices also have the potential to stage mucosa-based malignancy. The use of positron emission tomography has been the most recent development that may have application for advanced cancer. Endoscopic ultrasonography has also been improved in resolution and ability to perform fine needle aspiration. The most significant development for staging early cancers is mucosal resection. Finally, by using mucosal resection techniques, the depth of tumor invasion can be established by histology, which allows gastroenterologists to treat early cancers with greater confidence regarding rates of metastatic disease. SUMMARY Early detection of esophageal cancer can be enhanced by the use of vital dyes for mucosal staining, but the advancement of novel optical diagnostic strategies may be more suitable for clinical use. The primary advantage of these new staging methods is to clearly identify early stage cancer that potentially can be treated without traditional surgical resection techniques. More advanced cancers can be staged with positron emission tomography, but definitive studies demonstrating its role are still lacking.
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Affiliation(s)
- Kenneth K Wang
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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37
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Poneros JM. Diagnosis of Barrett's esophagus using optical coherence tomography. Gastrointest Endosc Clin N Am 2004; 14:573-88, x. [PMID: 15261203 DOI: 10.1016/j.giec.2004.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The presence of Barrett's esophagus (BE) is determined by histopathologic analysis of biopsy specimens obtained during upper endoscopy. The accuracy of endoscopy for the diagnosis of BE is surprisingly poor, however. Optical coherence tomography (OCT) is an optical technology that has shown promise as a powerful new tool to study BE. Of all the methods of optical biopsy discussed in this issue,perhaps OCT comes closest to this goal in that it provides a two dimensional image that correlates with traditional histopathologic excisional biopsy.
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Affiliation(s)
- John M Poneros
- Gastroenterology Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02114, USA.
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38
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Song LMWK, Wang KK. Optical detection and eradication of dysplastic Barrett's esophagus. Technol Cancer Res Treat 2003; 2:289-302. [PMID: 12892511 DOI: 10.1177/153303460300200403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dysplastic Barrett's esophagus is a condition that offers multiple diagnostic and therapeutic challenges. The diagnosis of dysplasia within Barrett's esophagus currently relies on periodic endoscopic surveillance with multiple biopsies, a methodology limited by random sampling error, inconsistent histopathologic interpretation and delay in diagnosis. Optical spectroscopic and imaging techniques have the potential to identify dysplastic or early neoplastic lesions in real-time. These diagnostic modalities are needed to enhance the endoscopic surveillance of Barrett's esophagus in the future as well as help to define lesions for endoscopic therapy. Esophagectomy has been the standard of care for Barrett's esophagus with high-grade dysplasia although it is a procedure associated with significant morbidity and mortality. Minimally invasive endoscopic ablative therapies are attractive and less morbid alternatives to esophagectomy, with promising results obtained from the use of light-activated drugs (i.e., photodynamic therapy). The combination of novel optical diagnostic techniques and therapies will provide the endoscopist with much needed tools that can considerably enhance the management of patients with Barrett's esophagus. This article reviews the current status and future prospects of optical-based modalities for diagnosis and therapy of dysplastic Barrett's esophagus.
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Abstract
PURPOSE The importance of an in-depth understanding about Barrett esophagus is ultimately to decrease the mortality and morbidity from esophageal adenocarcinoma cancer by early detection of metaplasia and dysplasia and appropriate therapy. This review summarizes several publications in the past year related to the epidemiology, pathogenesis, screening and surveillance, new methods for detection of metaplasia/dysplasia, and advances in the treatment of Barrett esophagus. RECENT FINDINGS Patients with Barrett esophagus are characterized by the presence of risk factors usually indicative of severe types of gastroesophageal reflux disease. Recent insights into epidemiology and pathogenesis have shown that the risk of high-grade dysplasia and adenocarcinoma may be related to the increasing length of Barrett esophagus, size of hiatus hernia, and severity of acid reflux. The role of smoking and alcohol consumption remains controversial. Increasing the number of biopsies by repeat standard endoscopy can enhance the yield of intestinal metaplasia in patients with suspected short-segment Barrett esophagus. Costs of surveillance using standard endoscopy and random biopsies would be very high and using special techniques to target specific areas could ultimately help in cost reduction. Emerging data on new techniques and technology such as vital staining with methylene blue and protoporphyrin fluorescence can increase the yield of metaplasia and dysplasia. Biomarkers studies have revealed that p53 mutation by the loss of heterozygosity can help detect patients with low and high risk for cancer progression. Studies thus far have been unclear whether acid suppression alone can impact the malignant progression in Barrett esophagus patients. Inhibition of cyclooxygenase by aspirin or nonsteroidal anti-inflammatory drugs may be a promising chemoprevention strategy against dysplasia and esophageal adenocarcinoma development as shown in some recent studies. Nonsurgical treatment by photodynamic therapy or mucosal resection may be a less invasive and organ-sparing option for some patients with high-grade dysplasia and early adenocarcinoma. SUMMARY In the past year we have made major strides in our knowledge of this premalignant lesion. Recent studies have shed light in a better understanding of the epidemiology of Barrett esophagus, including clinical and endoscopic factors associated with high-grade dysplasia or esophageal adenocarcinoma and various biomarkers that would identify patient subsets with low and high risk for cancer progression. This will eventually have significant implications on the screening, surveillance, and treatment of the disease. Advanced endoscopic therapies including mucosectomy or photodynamic therapy may be emerging options in patients with intraepithelial neoplasia.
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Affiliation(s)
- Sanjeev Slehria
- Division of Gastroenterology and Hepatology, University of Kansas, School of Medicine, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA
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40
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Poneros JM, Nishioka NS. Diagnosis of Barrett's esophagus using optical coherence tomography. Gastrointest Endosc Clin N Am 2003; 13:309-23. [PMID: 12916662 DOI: 10.1016/s1052-5157(03)00012-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OCT is a promising optical technology that permits real-time, high-resolution, cross-sectional imaging of tissue during endoscopy. It has been shown to be a highly sensitive and specific means of identifying the presence of SIM. Preliminary studies suggest that OCT is capable of grading dysplasia occurring within BE and has the potential to assist with the staging of superficial malignancies, particularly squamous cell cancers. In the near future, the capabilities of OCT systems are expected to improve with systems capable of much higher resolution and with Doppler capability becoming available.
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Affiliation(s)
- John M Poneros
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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