title: Large-area spectrally encoded confocal endomicroscopy of the human esophagus in vivo.
abstract: Diagnosis of esophageal diseases is often hampered by sampling errors that are inherent in endoscopic biopsy, the standard of care. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal endomicroscopy technology that has the potential to visualize cellular features from large regions of the esophagus, greatly decreasing the likelihood of sampling error. In this paper, we report results from a pilot clinical study imaging the human esophagus in vivo with a prototype SECM endoscopic probe.
  
  
  
  In this pilot clinical study, six patients undergoing esophagogastroduodenoscopy (EGD) for surveillance of Barrett's esophagus (BE) were imaged with the SECM endoscopic probe. The device had a diameter of 7 mm, a length of 2 m, and a rapid-exchange guide wire provision for esophageal placement. During EGD, the distal portion of the esophagus of each patient was sprayed with 2.5% acetic acid to enhance nuclear contrast. The SECM endoscopic probe was then introduced over the guide wire to the distal esophagus and large-area confocal images were obtained by helically scanning the optics within the SECM probe.
  
  
  
  Large area confocal images of the distal esophagus (image length = 4.3-10 cm; image width = 2.2 cm) were rapidly acquired at a rate of ∼9 mm2/second, resulting in short procedural times (1.8-4 minutes). SECM enabled the visualization of clinically relevant architectural and cellular features of the proximal stomach and normal and diseased esophagus, including squamous cell nuclei, BE glands, and goblet cells.
  
  
  
  This study demonstrates that comprehensive spectrally encoded confocal endomicroscopy is feasible and can be used to visualize architectural and cellular microscopic features from large segments of the distal esophagus at the gastroesophageal junction. By providing microscopic images that are less subject to sampling error, this technology may find utility in guiding biopsy and planning and assessing endoscopic therapy. Lasers Surg. Med. 49:233-239, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Dongkyun
authors.initials: D
authors.lastname: Kang
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Schlachter
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Carruth
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Minkyu
authors.initials: M
authors.lastname: Kim
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Nima
authors.initials: N
authors.lastname: Tabatabaei
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Amna R
authors.initials: AR
authors.lastname: Soomro
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Catriona N
authors.initials: CN
authors.lastname: Grant
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Mireille
authors.initials: M
authors.lastname: Rosenberg
authors.affiliation: Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Norman S
authors.initials: NS
authors.lastname: Nishioka
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts 02114.|Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114.|Harvard-MIT Division of Health Science and Technology, Cambridge, Massachusetts 02139.
authors.forename: Guillermo J
authors.initials: GJ
authors.lastname: Tearney
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D010865:Pilot Projects; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology*; D012494:Sampling Studies
keywords: Barrett's esophagus; confocal endomicroscopy; esophageal imaging; reflectance confocal microcopy; spectrally encoded confocal microscopy