359 Unsedated Screening for Barrett's Esophagus Using Tethered Capsule Endomicroscopy

Gora, Michalina J.; Soomro, Amna R.; Puricelli, William P.; Lu, Weina; Quijano, Elena; Moffitt, Lorissa A.; Rosenberg, Mireille; Sauk, Jenny; Nishioka, Norman S.; Tearney, Guillermo J.

doi:10.1016/j.gie.2014.02.090

Cited by 4 publications

(4 citation statements)

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“…Capsule imaging might also be used to indicate the approximate location of possible dysplastic features by noting the longitudinal position of the lesion (via markings on the tether) and its ‘clock position’ (location around the circumference) from the OCT image map to inform follow-up endoscopy and biopsy. Laser marking based on cross-sectional image guidance using tethered capsules has been reported 25 ; future capsule studies could adapt the laser marking paradigm to guide biopsy based on both en face and cross-sectional features.…”

Section: Discussionmentioning

confidence: 99%

“…Our capsule did not have the capability to mark areas of interest for biopsy or to obtain biopsy directly. However, laser marking based on cross-sectional image guidance using tethered capsules has been reported [24]. Future capsule studies could adapt the laser marking paradigm to guide biopsy based on both en face and crosssectional features.…”

Section: Discussionmentioning

confidence: 99%

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Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients

Liang

Ahsen

Murphy

et al. 2020

BMJ Open Gastroenterol

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ObjectiveBarrett’s oesophagus (BE) screening outside the endoscopy suite can identify patients for surveillance and reduce mortality. Tethered capsule optical coherence tomography (OCT) can volumetrically image oesophageal mucosa in unsedated patients and detect features of BE. We investigated ultrahigh-speed tethered capsule swept-source OCT (SS-OCT), improved device design, developed procedural techniques and measured capsule contact, longitudinal pullback non-uniformity and patient toleration.DesignOCT was performed in 16 patients prior to endoscopic surveillance/treatment. Unsedated patients swallowed the capsule with sips of water and the tether was pulled back to image the oesophagus. SS-OCT at 1 000 000 A-scans/s enabled imaging 10 cm oesophageal lengths in 10 s with 30 µm transverse and 8 µm axial resolution. Capsule contact, longitudinal image coverage and patient toleration were assessed.ResultsNine patients had non-dysplastic BE, three had ablative treatment-naïve neoplasia and four had prior ablation for dysplasia. Dry swallows facilitated capsule transit through the lower oesophageal sphincter (LES), and waiting 10 s before pullback reduced swallow induced LES relaxation. Slow nasal inhalation facilitated capsule retrieval and minimised gag reflex. The procedure was well tolerated. Ultrahigh-speed SS-OCT generated cross-sectional and subsurface en face images showing BE features, while subsurface en face images were required to assess the gastro-oesophageal junction. Candidate features of dysplasia were also identified which could inform follow-up endoscopy/biopsy. BE features were seen in all patients with histologically confirmed BE. Mean capsule contact over BE was 75%±27% for all patients and better in short segment BE. Mean longitudinal image coverage over BE was 59%±34% and better for long segment BE.ConclusionsUltrahigh-speed tethered capsule SS-OCT can image en face and cross-sectional mucosal features over wide areas. Device and procedure optimisation improved performance. BE features could be identified in all patients, but limited capsule contact and longitudinal coverage could cause sampling errors for focal pathologies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients

Liang

Ahsen

Murphy

et al. 2020

BMJ Open Gastroenterol

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“…Circumferential ablation catheters [55] and biopsy capsules [56] are known in endoscopic practice, and could be significantly improved with real-time image guidance. Laser marking of sites for biopsy using an imaging capsule has also been demonstrated [57]. However, the difficulty of delivering focal therapies using a capsule (unlike an inflated balloon, which is more stable but produces lower image quality) given motion between the capsule and the esophageal wall, is a challenging problem.…”

Section: Discussionmentioning

confidence: 99%

Ultrahigh speed en face OCT capsule for endoscopic imaging

Liang¹,

Traverso²,

Lee³

et al. 2015

Biomed. Opt. Express

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Depth resolved and en face OCT visualization in vivo may have important clinical applications in endoscopy. We demonstrate a high speed, two-dimensional (2D) distal scanning capsule with a micromotor for fast rotary scanning and a pneumatic actuator for precision longitudinal scanning. Longitudinal position measurement and image registration were performed by optical tracking of the pneumatic scanner. The 2D scanning device enables high resolution imaging over a small field of view and is suitable for OCT as well as other scanning microscopies. Large field of view imaging for screening or surveillance applications can also be achieved by proximally pulling back or advancing the capsule while scanning the distal high-speed micromotor. Circumferential en face OCT was demonstrated in living swine at 250 Hz frame rate and 1 MHz A-scan rate using a MEMS tunable VCSEL light source at 1300 nm. Crosssectional and en face OCT views of the upper and lower gastrointestinal tract were generated with precision distal pneumatic longitudinal actuation as well as proximal manual longitudinal actuation. These devices could enable clinical studies either as an adjunct to endoscopy, attached to an endoscope, or as a swallowed tethered capsule for non-endoscopic imaging without sedation. The combination of ultrahigh speed imaging and distal scanning capsule technology could enable both screening and surveillance applications. Kimmey

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“…Despite several in vivo OCT studies in the human gastrointestinal tract, the high cost and a lack of standardized terminology and large prospective data have limited the diffusion of this technique. An innovative, interesting, and simple application of OCT in the screening of Barrett's esophagus was presented by Gora et al [2]. The authors reported the first human experience using tethered capsule endomicroscopy in 53 patients.…”

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confidence: 99%

Endoscopy innovations

2014

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Innovation everywhere for everybody - this is the way we can summarize the 2014 Digestive Disease Week, which was held in Chicago, Illinois, last May. Many sessions introduced new innovative materials and concepts. From the robot of the future to the simplest ideas, the congress was fertile and sometimes full of surprises. Abstracts representing significant progress and innovations in the field of digestive endoscopy are reviewed here.

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359 Unsedated Screening for Barrett's Esophagus Using Tethered Capsule Endomicroscopy

Cited by 4 publications

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Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients

Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients

Ultrahigh speed en face OCT capsule for endoscopic imaging

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