Evaluation of a novel infra-red endoscopy system in the assessment of early neoplasia in Barretts esophagus: pilot study from a single center

Abstract

Infrared endoscopy (IRE) has been shown to be useful in detecting submucosal (SM) invasion in early gastric cancer. Its role in the endoscopic assessment of Barrett's neoplasia has not been reported to date. We aimed in this study to evaluate the role of IRE in the detection and characterization of early neoplastic lesions within Barrett's esophagus (BE). The secondary aim was to explore its usefulness for the assessment of the presence of submucosal invasion in these early neoplastic Barrett's lesions. We included in the study patients with dysplastic BE who were referred to our institution for endoscopic therapy of a previously diagnosed early Barrett's neoplasia. An examination with white light high resolution endoscopy (HRE) and near IRE after intravenous injection of indocyanine green was performed for all patients using an infrared endoscope prototype. Staining on IRE and correlation with final histological staging by endoscopic mucosal resection/surgery or histological diagnosis on mapping biopsies was analyzed. A total of 23 patients were enrolled in our study: 17 of them with 19 visible lesions and 6 patients with flat BE and no lesions. Staining on IRE was noted in 18 cases: 17 (94%) had at least high grade dysplasia (HGD). No stain was noted in 7 cases: final histology was <HGD in 5 (71%) and ≥HGD in 2 (29%). There was statistically significant difference between cases with no stain and any staining on IRE with regard to the presence of ≥HGD [2/7 (29%) vs. 17/18 (94%) P = 0.0022]. Stain was reported as faint in 12 and dense in 6. All 6 cases with dense staining had at least HGD. We concluded that IRE can provide additional information to the currently available white light endoscopy for detecting early neoplastic lesions within BE. IRE also allows detecting HGD and most advanced histology in BE. Usefulness of IRE to detect submucosal involvement in early Barrett's neoplastic lesions needs to be assessed further in larger cohort studies.

Fluorescence guided intraluminal endoscopy in the gastrointestinal tract: A systematic review

“…Two studies classified the fluorescence staining as no tumor stain, homogeneous tumor stain, inhomogeneous tumor stain, or pooling of the dye[ 12 , 25 ], while another study categorized the staining as no stain, faint stain, dense stain, homogeneous stain, and pooling of the dye. The definitions were as follows; no stain: A decreased dye accumulation in the tumor compared to surrounding mucosa, homogeneous stain: A diffusely increased dye accumulation in the tumor compared with the surrounding mucosa, inhomogeneous stain: A scattered dye accumulation in the tumor, and pooling of the dye: A substantial dye accumulation in the tumor[ 24 ]. In another two studies, they categorized the pooling of the dye/fluorescence categorized as positive or negative[ 21 , 23 ].…”

“…The dose of ICG ranged from 0.001 to 5 mg/kg bodyweight varying between a fixed dose or different doses of ICG. Four studies reported no adverse events according to ICG[ 21 - 24 ], and the remaining two did not report the frequency or absence of adverse events[ 12 , 25 ]. One study made a dose-response test for Bevacizumab-800CW, which was used as a fluorophore labeling Vascular Endothelial Growth Factor A present in colorectal adenomas and reported no adverse events according to the injections and doses (Table 3 )[ 15 ].…”

“…One study examined early neoplastic lesions within Barrett’s esophagus in 23 cases[ 24 ]. Seven cases showed no stain, and histology showed less than high-grade dysplasia in five of those seven cases.…”

“…The contrast has been commercially available for many years, as it has a high level of safety and a very low incidence of adverse events has been reported[ 31 , 32 ]. In this systematic review, four of six included studies ( n = 106) using ICG specifically reported that no adverse effects occurred[ 21 - 24 ], while the remaining two studies reporting nothing on adverse events. Usually, the recommended dosage of ICG is 0.2-0.25 mg/kg, which must not exceed 2 mg/kg in total[ 33 ].…”

Application of endoscopic tattooing in intraoperative localization of colon tumours and sentinel lymph nodes

“…Today, ICG has many applications, such as determining cardiac output and liver function. It is also used in angiography, lymph node mapping, lymphatic drainage, detection of early cancer in Barrett's oesophagus, and to assess tissue perfusion and blood supply to gastrointestinal anastomoses [23]. Iodine allergy is a contraindication to ICG [6].…”