Cargando…

Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients

OBJECTIVE: Barrett’s oesophagus (BE) screening outside the endoscopy suite can identify patients for surveillance and reduce mortality. Tethered capsule optical coherence tomography (OCT) can volumetrically image oesophageal mucosa in unsedated patients and detect features of BE. We investigated ult...

Descripción completa

Detalles Bibliográficos
Autores principales: Liang, Kaicheng, Ahsen, Osman O, Murphy, Annalee, Zhang, Jason, Nguyen, Tan H, Potsaid, Benjamin, Figueiredo, Marisa, Huang, Qin, Mashimo, Hiroshi, Fujimoto, James G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473663/
https://www.ncbi.nlm.nih.gov/pubmed/32883714
http://dx.doi.org/10.1136/bmjgast-2020-000444
_version_ 1783579221876015104
author Liang, Kaicheng
Ahsen, Osman O
Murphy, Annalee
Zhang, Jason
Nguyen, Tan H
Potsaid, Benjamin
Figueiredo, Marisa
Huang, Qin
Mashimo, Hiroshi
Fujimoto, James G
author_facet Liang, Kaicheng
Ahsen, Osman O
Murphy, Annalee
Zhang, Jason
Nguyen, Tan H
Potsaid, Benjamin
Figueiredo, Marisa
Huang, Qin
Mashimo, Hiroshi
Fujimoto, James G
author_sort Liang, Kaicheng
collection PubMed
description OBJECTIVE: Barrett’s oesophagus (BE) screening outside the endoscopy suite can identify patients for surveillance and reduce mortality. Tethered capsule optical coherence tomography (OCT) can volumetrically image oesophageal mucosa in unsedated patients and detect features of BE. We investigated ultrahigh-speed tethered capsule swept-source OCT (SS-OCT), improved device design, developed procedural techniques and measured capsule contact, longitudinal pullback non-uniformity and patient toleration. DESIGN: OCT was performed in 16 patients prior to endoscopic surveillance/treatment. Unsedated patients swallowed the capsule with sips of water and the tether was pulled back to image the oesophagus. SS-OCT at 1 000 000 A-scans/s enabled imaging 10 cm oesophageal lengths in 10 s with 30 µm transverse and 8 µm axial resolution. Capsule contact, longitudinal image coverage and patient toleration were assessed. RESULTS: Nine patients had non-dysplastic BE, three had ablative treatment-naïve neoplasia and four had prior ablation for dysplasia. Dry swallows facilitated capsule transit through the lower oesophageal sphincter (LES), and waiting 10 s before pullback reduced swallow induced LES relaxation. Slow nasal inhalation facilitated capsule retrieval and minimised gag reflex. The procedure was well tolerated. Ultrahigh-speed SS-OCT generated cross-sectional and subsurface en face images showing BE features, while subsurface en face images were required to assess the gastro-oesophageal junction. Candidate features of dysplasia were also identified which could inform follow-up endoscopy/biopsy. BE features were seen in all patients with histologically confirmed BE. Mean capsule contact over BE was 75%±27% for all patients and better in short segment BE. Mean longitudinal image coverage over BE was 59%±34% and better for long segment BE. CONCLUSIONS: Ultrahigh-speed tethered capsule SS-OCT can image en face and cross-sectional mucosal features over wide areas. Device and procedure optimisation improved performance. BE features could be identified in all patients, but limited capsule contact and longitudinal coverage could cause sampling errors for focal pathologies.
format Online
Article
Text
id pubmed-7473663
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-74736632020-09-16 Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients Liang, Kaicheng Ahsen, Osman O Murphy, Annalee Zhang, Jason Nguyen, Tan H Potsaid, Benjamin Figueiredo, Marisa Huang, Qin Mashimo, Hiroshi Fujimoto, James G BMJ Open Gastroenterol Imaging OBJECTIVE: Barrett’s oesophagus (BE) screening outside the endoscopy suite can identify patients for surveillance and reduce mortality. Tethered capsule optical coherence tomography (OCT) can volumetrically image oesophageal mucosa in unsedated patients and detect features of BE. We investigated ultrahigh-speed tethered capsule swept-source OCT (SS-OCT), improved device design, developed procedural techniques and measured capsule contact, longitudinal pullback non-uniformity and patient toleration. DESIGN: OCT was performed in 16 patients prior to endoscopic surveillance/treatment. Unsedated patients swallowed the capsule with sips of water and the tether was pulled back to image the oesophagus. SS-OCT at 1 000 000 A-scans/s enabled imaging 10 cm oesophageal lengths in 10 s with 30 µm transverse and 8 µm axial resolution. Capsule contact, longitudinal image coverage and patient toleration were assessed. RESULTS: Nine patients had non-dysplastic BE, three had ablative treatment-naïve neoplasia and four had prior ablation for dysplasia. Dry swallows facilitated capsule transit through the lower oesophageal sphincter (LES), and waiting 10 s before pullback reduced swallow induced LES relaxation. Slow nasal inhalation facilitated capsule retrieval and minimised gag reflex. The procedure was well tolerated. Ultrahigh-speed SS-OCT generated cross-sectional and subsurface en face images showing BE features, while subsurface en face images were required to assess the gastro-oesophageal junction. Candidate features of dysplasia were also identified which could inform follow-up endoscopy/biopsy. BE features were seen in all patients with histologically confirmed BE. Mean capsule contact over BE was 75%±27% for all patients and better in short segment BE. Mean longitudinal image coverage over BE was 59%±34% and better for long segment BE. CONCLUSIONS: Ultrahigh-speed tethered capsule SS-OCT can image en face and cross-sectional mucosal features over wide areas. Device and procedure optimisation improved performance. BE features could be identified in all patients, but limited capsule contact and longitudinal coverage could cause sampling errors for focal pathologies. BMJ Publishing Group 2020-09-03 /pmc/articles/PMC7473663/ /pubmed/32883714 http://dx.doi.org/10.1136/bmjgast-2020-000444 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Imaging
Liang, Kaicheng
Ahsen, Osman O
Murphy, Annalee
Zhang, Jason
Nguyen, Tan H
Potsaid, Benjamin
Figueiredo, Marisa
Huang, Qin
Mashimo, Hiroshi
Fujimoto, James G
Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title_full Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title_fullStr Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title_full_unstemmed Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title_short Tethered capsule en face optical coherence tomography for imaging Barrett’s oesophagus in unsedated patients
title_sort tethered capsule en face optical coherence tomography for imaging barrett’s oesophagus in unsedated patients
topic Imaging
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473663/
https://www.ncbi.nlm.nih.gov/pubmed/32883714
http://dx.doi.org/10.1136/bmjgast-2020-000444
work_keys_str_mv AT liangkaicheng tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT ahsenosmano tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT murphyannalee tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT zhangjason tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT nguyentanh tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT potsaidbenjamin tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT figueiredomarisa tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT huangqin tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT mashimohiroshi tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients
AT fujimotojamesg tetheredcapsuleenfaceopticalcoherencetomographyforimagingbarrettsoesophagusinunsedatedpatients