In Vivo Endoscopic Optical Coherence Tomography of the Human Gastrointestinal Tract - Toward Optical Biopsy

Background and Study Aims: Optical coherence tomography (OCT) is a new technique for high-resolution cross-sectional imaging using infrared light. It has over 10 times the resolution of the currently available ultrasonography. Although in vitro studies have suggested its potential for gastrointestinal imaging, in vivo studies have not been possible so far on account of technical limitations.

Patients and Methods: We describe here the first clinical study of OCT during routine endoscopy obtaining high resolution images of the normal esophageal, gastric, and colonic mucosa. Portable OCT equipment and a fiberoptic-based flexible probe for endoscopic use have been developed by the authors.

Results: Differences in the optical properties of epithelium, lamina propria, muscularis mucosae, and submucosa enabled distinction of the mucosal architecture. Owing to the low penetration depth (1 mm) and high resolution (10 μm), OCT images may become comparable to mucosal histological findings. Image acquisition time was 1.5 seconds, and the entire procedure was completed within 5 minutes. Endoscopic OCT images of colonic adenoma and carcinoma were also studied and compared with the corresponding histology.

Conclusions: The newly developed portable OCT equipment and flexible fiberoptic probe makes OCT a promising method for endoscopic “optical biopsy”.

References

• 1 Huang D, Swanson E A, Lin C P, et al. Optical coherence tomography.  Science. 1991;  254 1178-1181
• 2 Fercher A F, Hitzenberger C K, Drexler W, et al. In vivo optical coherence tomography.  Am J Ophthalmol. 1993;  116 113-115
• 3 Swanson E A, Izatt J A, Hee M R, et al. In vivo retinal imaging by optical coherence tomography.  Optics Lett. 1993;  18 1864-1866
• 4 Gelikonov V M, Gelikonov G V, Kuranov R V, et al. Coherent optical tomography of microscopic inhomogeneities in biological tissues.  Pis'ma Zh Eksp Teor Fiz. 1995;  61 149-153
• 5 Kobayashi K, Izatt J A, Kulkarni M D, et al. High-resolution cross-sectional imaging of the gastrointestinal tract using optical coherence tomography: preliminary results.  Gastrointest Endosc. 1998;  47 515-523
• 6 Brezinski M E, Tearney G J, Bouma B, et al. Optical biopsy with optical coherence tomography.  Ann N Y Acad Sci. 1998;  838 68-74
• 7 Brezinski M E, Fujimoto J G. Optical coherence tomography: high resolution imaging in nontransparent tissue.  IEEE J Selected Top Quantum Electronics. 1999;  5 1185-1192
• 8 Tearney G J, Brezinski M E, Bouma B E, et al. In vivo endoscopic optical biopsy with optical coherence tomography.  Science. 1997;  276 2037-2039
• 9 Bouma B E, Tearney G J. Power-efficient, non-reciprocal interferometer and linear scanning fibre-optic catheter for optical coherence tomography.  Optics Lett. 1999;  24 531-533
• 10 Sivak M V, Kobayashi K, Izatt J A, et al. In vivo high-resolution cross sectional imaging of the human gastrointestinal tract using optical coherence tomography.  Gastrointest Endosc. 1999;  49 AB159
• 11 Bouma B E, Tearney G Y, Compton C C, et al. Endoscopic optical coherence tomography of the gastrointestinal tract.  Gastrointest Endosc. 1999;  49 AB152
• 12 Brand S, Bouma B E, Tearney G J, et al. Optical coherence tomography (OCT) in the upper gastrointestinal tract.  Endoscopy. 1999;  31 (Suppl. 1) E1
• 13 Gelikonov V M, Sergeev A M, Gelikonov G V, et al. Compact fast-scanning OCT device for in vivo biotissue imaging.  In: Conference on lasers and electro-optics, OSA technical digest series.  Baltimore; Optical Society of America, 1996: 58
• 14 Sergeev A M, Gelikonov V M, Gelikonov G V, et al. In vivo endoscopic OCT imaging of precancer and cancer states of human mucosa.  Optics Express. 1997;  1 432-440
• 15 Feldchtein F I, Gelikonov G V, Gelikonov V M, et al. Endoscopic applications of optical coherence tomography.  Optics Express. 1998;  3 257-269
• 16 Pitris C, Goodman A, Boppart S A, et al. High resolution imaging of gynecologic neoplasms using optical coherence tomography.  Obstet Gynecol. 1999;  93 135-139
• 17 Hosokawa O, Tsuda S, Kidani E, et al. Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 669-674
• 18 Fujii T, Rembacken B J, Dixon M F, et al. Flat adenomas in the United Kingdom: are treatable cancers being missed?.  Endoscopy. 1998;  30 437-443
• 19 Hart A R, Kudo S, Mackay E H, et al. Flat adenoma exist in asymptomatic people: important implications for colorectal cancer screening programmes.  Gut. 1998;  43 229-231
• 20 Ban S, Toyonaga A, Harada H, et al. Iodine staining for early endoscopic detection of esophageal cancer in alcoholics.  Endoscopy. 1998;  30 253-257
• 21 Morales T G, Bhattacharyya A, Camargo E, et al. Methylene blue staining for intestinal metaplasia of the gastric cardia with follow-up for dysplasia.  Gastrointest Endosc. 1998;  48 26-31
• 22 Guelrud M, Herrera I. Acetic acid improves identification of remnant islands of Barrett's epithelium after endoscopic therapy.  Gastrointest Endosc. 1998;  47 512-515
• 23 Panjehpour M, Overholt B F, Vo-Dinh T, et al. Endoscopic fluorescence detection of high-grade dysplasia in Barrett's esophagus.  Gastroenterology. 1996;  11 93-101
• 24 Messmann H, Kullmann F, Wild T, et al. Detection of dysplastic lesions by fluorescence in a model of colitis in rats after previous photosensitization with 5-aminolaevulinic acid.  Endoscopy. 1998;  30 333-338
• 25 Yanai H, Matsumoto Y, Harada T, et al. Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study.  Gastrointest Endosc. 1997;  46 212-216
• 26 Boppart S A, Bouma B E, Pitris C, et al. In vivo cellular optical coherence tomography imaging.  Nat Med. 1998;  4 861-865
• 27 Jäckle S, Gladkova N, Feldchtein F, et al. In vivo endoscopic optical coherence tomography of esophagitis, Barrett's esophagus, and adenocarcinoma of the esophagus.  Endoscopy. 2000;  32 750-755
• 28 Tearney G J, Brezinski M E, Southern J F, et al. Optical biopsy in human urologic tissue using optical coherence tomography.  J Urol. 1997;  157 1915-1919
• 29 Gladkova N D, Petrova G A, Nikulin N K, et al. In vivo optical coherence tomography imaging of human skin: normal and pathology.  Skin Res Technol. 2000;  6 6-16