Endoscopy 2005; 37(6): 587-590
DOI: 10.1055/s-2005-861327
Innovation Forum
© Georg Thieme Verlag KG Stuttgart · New York

Optical Coherence Tomography of Barrett’s Esophagus

A.  Chak1 , M.  B.  Wallace2 , J.  M.  Poneros3
  • 1Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, USA
  • 2Mayo Clinic, Jacksonville, Florida, USA
  • 3Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Further Information

Publication History

Publication Date:
03 June 2005 (online)

Objectives

The endoscopic diagnosis of specialized intestinal metaplasia (Barrett’s esophagus) and dysplasia can be surprisingly difficult, especially when only short lengths of Barrett’s esophagus are suspected. Various imaging techniques have been used to aid the endoscopic diagnosis of Barrett’s esophagus and the staging of early neoplasia, including endoscopic ultrasound, magnification endoscopy, and the application of chemical stains and pigments to alter tissue appearances (i. e. chromoendoscopy). The ultimate goals of these advanced imaging methods are to: (i) detect intestinal metaplasia in the background of gastric metaplasia of the esophagus; (ii) detect foci of dysplasia and early neoplasia in the background of intestinal metaplasia; and (iii) distinguish early invasive carcinoma from mucosal dysplasia. Increasing amounts of data are available on the use of endoscopic optical coherence tomography (OCT) to aid in the diagnosis and classification of Barrett’s esophagus and associated dysplasia. OCT is a cross-sectional imaging technique that provides the highest endoscopic resolution currently available and produces images to a depth of a few millimeters. The in vivo resolution of OCT imaging (∼ 10 µm) is more than ten times greater than that of high-frequency ultrasound and has the potential to visualize subcellular structures including nuclei. OCT is analogous to ultrasound but uses light waves rather than acoustic waves.

OCT provides images in real time with a resolution approaching that found in conventional histopathology, but without the need for tissue removal; thus it is termed “optical biopsy”. The resolution of OCT allows visualization of the different layers of gastrointestinal epithelium and has been demonstrated to reliably distinguish Barrett’s epithelium from normal gastric and squamous mucosa. Preliminary data also suggest that OCT may be useful in detecting dysplasia in Barrett’s esophagus. Although still in its infancy as a clinical tool, OCT has great potential in the study of the presence and natural history of Barrett’s esophagus.

References

  • 1 Sergeev A M, Gelikonov V M, Gelikonov G V. et al . In vivo endoscopic OCT imaging of precancer and cancer states of human mucosa.  Opt Express. 1997;  1 432-440
  • 2 Sivak M V Jr, Kobayashi K, Izatt J A. et al . High-resolution endoscopic imaging of the GI tract using optical coherence tomography.  Gastrointest Endosc. 2000;  51 474-479
  • 3 Bouma B E, Tearney G J, Compton C C. et al . High resolution of the human esophagus and stomach in vivo using optical coherence tomography.  Gastrointest Endosc. 2000;  51 467-474
  • 4 Poneros J M, Brand S, Bouma B E. et al . Diagnosis of specialized intestinal metaplasia by optical coherence tomography.  Gastroenterology. 2001;  120 7-12
  • 5 Wallace M B, Perelman L T, Backman V. et al . Endoscopic detection of dysplasia in patients with Barrett’s esophagus using light-scattering spectroscopy.  Gastroenterology. 2000;  119 677-682
  • 6 Zuccaro G, Gladkova N, Vargo J. et al . Optical coherence tomography of the esophagus and stomach in health and disease.  Am J Gastroenterol. 2001;  96 2633-2639
  • 7 Li X D, Boppart S A, van Dam J. et al . Optical coherence tomography: advanced technology for the endoscopic imaging of Barrett’s esophagus.  Endoscopy. 2000;  32 921-930
  • 8 Wang R K, Elder J B. Propylene glycol as a contrasting agent for optical coherence tomography to image gastrointestinal tissues.  Lasers Surg Med. 2002;  30 201-208
  • 9 Nishioka N S, Schomacker K T. Mucosal exposure to light during routine endoscopy.  Gastrointest Endosc. 1999;  49 456-461
  • 10 Poneros J M, Tearney G J, Shiskov M. et al . Optical coherence tomography of the biliary tree during ERCP.  Gastrointest Endosc. 2002;  55 84-88

J. M. Poneros, M. D.

Brigham and Women’s Hospital · Harvard Medical School

75 Francis Street · Boston, MA 02115 · USA

Fax: +1-617-732-7407

Email: jponeros@partners.org