Modular video endoscopy forin vivocross-polarized and vital-dye fluorescence imaging of Barrett’s-associated neoplasia

Abstract

Abstract. A modular video endoscope is developed and tested to allow imaging in different modalities. This system incorporates white light imaging (WLI), cross-polarized imaging (CPI), and vital-dye fluorescence imaging (VFI), using interchangeable filter modules. CPI and VFI are novel endoscopic modalities that probe mucosal features associated with Barrett's neoplasia. CPI enhances vasculature, while VFI enhances glandular architecture. In this pilot study, we demonstrate the integration of these modalities by imaging areas of Barrett's metaplasia and neoplasia in an esophagectomy specimen. We verify that those key image features are also observed during an in vivo surveillance procedure. CPI images demonstrate improved visualization of branching blood vessels associated with neoplasia. VFI images show glandular architecture with increased glandular effacement associated with neoplasia. Results suggests that important pathologic features seen in CPI and VFI are not visible during standard endoscopic white light imaging, and thus the modalities may be useful in future in vivo studies for discriminating neoplasia from Barrett's metaplasia. We further demonstrate that the integrated WLI/CPI/VFI endoscope is compatible with complementary high-resolution endomicroscopy techniques such as the high-resolution microendoscope, potentially enabling two-step ("red-flag" widefield plus confirmatory high-resolution imaging) protocols to be enhanced. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

Polarised stereo endoscope and narrowband detection for minimal access surgery

“…The feasibility of using polarisation during a flexible endoscopy was demonstrated recently in a study of Barrett's oesophagus where crossed-polarisation was used to improve the visibility of the microvasculature [6]. Quantitative endoscopic tissue polarisation characterisation using a custom-built laparoscope has also been investigated in ex vivo tissue [7,8].…”

Quantitative evaluation ofin vivovital-dye fluorescence endoscopic imaging for the detection of Barrett’s-associated neoplasia

“…28 In vivo images acquired with the system suggest that VFI enhances the ability to identify regions of glandular effacement, 28 a hallmark of neoplastic progression, which can then be interrogated with higher spatial resolution imaging modalities, potentially enabling a wide-field and confirmatory high-resolution surveillance protocol. 28 Here, we describe results from a 14 patient pilot study using the MVE to identify early-neoplastic lesions in BE. Images of 65 sites were analyzed to identify relevant quantitative VFI image features that could be used to classify BE as neoplastic or non-neoplastic.…”

“…Alternatively, topically administered vital-dye such as proflavine hemisulfate has been shown to improve visualization of mucosal architecture in the gastrointestinal (GI) tract when coupled with wide-field and high-resolution fluorescence imaging. 27,28 A modular video endoscope (MVE) capable of in vivo vitaldye fluorescence imaging (VFI) has recently been developed. 28 In vivo images acquired with the system suggest that VFI enhances the ability to identify regions of glandular effacement, 28 a hallmark of neoplastic progression, which can then be interrogated with higher spatial resolution imaging modalities, potentially enabling a wide-field and confirmatory high-resolution surveillance protocol.…”

“…27,28 A modular video endoscope (MVE) capable of in vivo vitaldye fluorescence imaging (VFI) has recently been developed. 28 In vivo images acquired with the system suggest that VFI enhances the ability to identify regions of glandular effacement, 28 a hallmark of neoplastic progression, which can then be interrogated with higher spatial resolution imaging modalities, potentially enabling a wide-field and confirmatory high-resolution surveillance protocol. 28 Here, we describe results from a 14 patient pilot study using the MVE to identify early-neoplastic lesions in BE.…”

Diagnosis of Neoplasia in Barrett’s Esophagus using Vital-dye Enhanced Fluorescence Imaging

“…VFI is a novel technique that combines high-resolution epithelial imaging with exogenous topical fluorescent contrast, proflavine, to highlight glandular morphology and delineate neoplasia (high grade dysplasia and cancer) in the distal esophagus in hopes of improving the in vivo diagnosis 6 . Upon excitation of the proflavine, which concentrates within cell nuclei shortly after application, the fluorescent images provide spatial resolution of 50 to 100 μm and a field of view up to 2.5 cm, allowing endoscopists to visualize glandular morphology.…”