Barrett's esophagus (BE) is a metaplastic condition that is associated with chronic gastroesophageal reflux disease (GERD). BE is important because it can progress to esophageal adenocarcinoma, a cancer with a high mortality rate and a rapidly rising incidence. Since identification of BE with dysplasia or early cancer can lead to cure, gastroenterological societies recommend that patients with GERD be screened by upper endoscopy Annually, ~720,000 Americans are endoscopically screened for BE, resulting in nearly a $1B cost to our health care system, a number that would increase significantly if all patients at risk for BE were screened. Nearly half of this cost is a consequence of patient sedation during the procedure. Another limitation of endoscopy is poor diagnostic performance, as recent studies have shown that this procedure has an accuracy of less than 50% for identifying BE. These shortcomings of upper endoscopy make it a good target for improvement. In the prior funding period we have developed a new technology called optical frequency domain imaging (OFDI), that is capable of acquiring depth-resolved microscopic image data at very high speeds in vivo. Using a balloon-centering optical catheter, we have demonstrated in approximately 100 patients that OFDI can safely acquire detailed three- dimensional images of the entire distal esophagus in a few minutes and that the sensitivity of this technique may be equivalent to or possibly better than that of endoscopy. Since our studies have focused on assessing feasibility and diagnostic potential, we have deployed OFDI as an adjunct to endoscopy under conscious sedation. In this proposal we will advance balloon-catheter OFDI technology so that it can be used for BE screening without sedation. We will accomplish this task by increasing the speed of OFDI by approximately a factor of 10 and by developing and comparing two novel balloon-catheter devices: a transnasal probe and a tethered capsule that can be swallowed. We will then determine the sensitivity and specificity of unsedated balloon catheter OFDI for BE diagnosis using a laser marking method to register OFDI images to biopsy. Finally, we will conduct a clinical study in 300 patients with GERD to test the hypothesis that unsedated balloon-catheter OFDI is more sensitive than endoscopy. In the end, we will have developed and validated an improved screening tool for BE that is less expensive and more accurate than the current standard of care.

Public Health Relevance

This proposal will develop a novel screening method for Barrett's esophagus that can be inserted transnasally or swallowed and can obtain microscopic images of the entire esophagus. We will validate the accuracy of this device and will then compare it to endoscopy, the current standard of care, in a clinical study of 300 patients.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA103769-10
Application #
8695087
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Baker, Houston
Project Start
2003-08-01
Project End
2015-05-31
Budget Start
2014-06-01
Budget End
2015-05-31
Support Year
10
Fiscal Year
2014
Total Cost
$464,015
Indirect Cost
$201,860
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Ughi, Giovanni J; Gora, Michalina J; Swager, Anne-Fré et al. (2016) Automated segmentation and characterization of esophageal wall in vivo by tethered capsule optical coherence tomography endomicroscopy. Biomed Opt Express 7:409-19
Gora, Michalina J; Simmons, Leigh H; Quénéhervé, Lucille et al. (2016) Tethered capsule endomicroscopy: from bench to bedside at a primary care practice. J Biomed Opt 21:104001
Conti de Freitas, Luiz C; Phelan, Eimear; Liu, Linbo et al. (2014) Optical coherence tomography imaging during thyroid and parathyroid surgery: a novel system of tissue identification and differentiation to obviate tissue resection and frozen section. Head Neck 36:1329-34
Gora, Michalina J; Sauk, Jenny S; Carruth, Robert W et al. (2013) Tethered capsule endomicroscopy enables less invasive imaging of gastrointestinal tract microstructure. Nat Med 19:238-40
Gora, Michalina J; Sauk, Jenny S; Carruth, Robert W et al. (2013) Imaging the upper gastrointestinal tract in unsedated patients using tethered capsule endomicroscopy. Gastroenterology 145:723-5
Sauk, Jenny; Coron, Emmanuel; Kava, Lauren et al. (2013) Interobserver agreement for the detection of Barrett's esophagus with optical frequency domain imaging. Dig Dis Sci 58:2261-5
Coron, E; Auksorius, E; Pieretti, A et al. (2012) Full-field optical coherence microscopy is a novel technique for imaging enteric ganglia in the gastrointestinal tract. Neurogastroenterol Motil 24:e611-21
Gora, Michalina; Yoo, Hongki; Suter, Melissa J et al. (2011) Optical frequency domain imaging system and catheters for volumetric imaging of the human esophagus. Photonics Lett Pol 3:144-146
Choma, Michael A; Suter, Melissa J; Vakoc, Benjamin J et al. (2011) Physiological homology between Drosophila melanogaster and vertebrate cardiovascular systems. Dis Model Mech 4:411-20
Oh, Wang-Yuhl; Vakoc, Benjamin J; Shishkov, Milen et al. (2010) >400 kHz repetition rate wavelength-swept laser and application to high-speed optical frequency domain imaging. Opt Lett 35:2919-21

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