Near-infrared fluorescence cholangiopancreatoscopy: initial clinical feasibility results.
BACKGROUND
The recent clinical propagation of targeted fluorescence agents brings a promising alternative in endoscopy by complementing visual disease detection with molecular biomarkers.


OBJECTIVE
Development of near-infrared (NIR) fluorescence cholangiopancreatoscopy in real-time and validation of its clinical use.


METHODS
Feasibility study.


METHODS
Tertiary referral center at a large university hospital.


METHODS
Patients with pancreatic and biliary diseases.


METHODS
Routine cholangiopancreatoscopy with additional wide-field NIR fluorescence imaging.


METHODS
We adapted a miniature cholangioscope for real-time concurrent wide-field color and NIR fluorescence imaging. Illumination is provided through a custom-designed fiber bundle, and the acquired images are relayed via a dichroic beam splitter to 2 charge-coupled devices for simultaneous measurement. We characterize the sensitivity and resolution and demonstrate the clinical feasibility by detecting indocyanine green localization in 2 patients.


RESULTS
A spatial optical resolution of approximately 50 μm was achieved, and fluorescent dye concentrations of 17.3 nM could be detected. Elevated fluorescence signals were detected during clinical measurements, and biopsy specimens confirmed the presence of malignancy in both patients.


CONCLUSIONS
Feasibility study, limited number of patients.


CONCLUSIONS
The results demonstrate that real-time wide-field fluorescence detection in the NIR range is possible in humans by using adapted endoscopes. The feasibility of detecting indocyanine green in the pancreatobiliary ducts is verified, suggesting that cancer screening at a molecular level might play an increasingly important role in the future.
Technical University of Munich, Munich, Germany.
Jürgen
J
Glatz
Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
P Beatriz
PB
Garcia-Allende
II. Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Valentin
V
Becker
Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
Maximilian
M
Koch
II. Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Alexander
A
Meining
Technical University of Munich, Munich, Germany; Institute for Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany.
Vasilis
V
Ntziachristos
D001660:Biliary Tract Diseases / Q000175:diagnosis*; D004396:Coloring Agents; D016145:Endoscopy, Digestive System / Q000379:methods*; D005240:Feasibility Studies; D005453:Fluorescence; D005456:Fluorescent Dyes; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis*
D004396:Coloring Agents; D005456:Fluorescent Dyes; D007208:Indocyanine Green