Abstract
Background and study aims Endoscopic surveillance for Barrett’s esophagus (BE) is limited by long procedure times and sampling error. Near-infrared (NIR) fluorescence imaging minimizes tissue autofluorescence and optical scattering. We assessed the feasibility of a topically applied NIR dye-labeled lectin for the detection of early neoplasia in BE in an ex vivo setting. Methods Consecutive patients undergoing endoscopic mucosal resection (EMR) for BE-related early neoplasia were recruited. Freshly collected EMR specimens were sprayed at the bedside with fluorescent lectin and then imaged. Punch biopsies were collected from each EMR under NIR light guidance. We compared the fluorescence intensity from dysplastic and nondysplastic areas within EMRs and from punch biopsies with different histological grades. Results 29 EMR specimens were included from 17 patients. A significantly lower fluorescence was found for dysplastic regions across whole EMR specimens ( P < 0.001). We found a 41 % reduction in the fluorescence of dysplastic compared to nondysplastic punch biopsies ( P < 0.001), with a sensitivity and specificity for dysplasia detection of 80 % and 82.9 %, respectively. Conclusion Lectin-based NIR imaging can differentiate dysplastic from nondysplastic Barrett’s mucosa ex vivo.
Highlights
The incidence of esophageal adenocarcinoma (EAC) has increased dramatically in the Western world over the last 30 years
Using wheat germ agglutinin (WGA)-IR800 as an imaging agent, applied topically to endoscopic mucosal resection (EMR) specimens ex vivo, we observed a significant reduction of NIR fluorescence in areas containing dysplasia, in comparison with nondysplastic areas (P < 0.001, ▶ Fig. 1a)
Higher negative contrast was obtained for EMRs containing larger areas of dysplasia and the spatial extent of the latter was found to correlate with NIR fluorescence imaging contrast ( ▶ Fig.1b)
Summary
The incidence of esophageal adenocarcinoma (EAC) has increased dramatically in the Western world over the last 30 years. Neves André A et al Detection of early neoplasia in Barrett’s esophagus using near-infrared imaging. Endoscopy 2018; 50: 618–625 around 0.3 % per year, endoscopic surveillance of BE is recommended [2] as early diagnosis of EAC is associated with improved patient outcome [3]. Endoscopic surveillance is generally performed according to the Seattle protocol, which entails 4 biopsies every 2 centimeters within the BE segment, but is affected by sampling error due to inconspicuous dysplasia and sampling error [2]. This protocol is time-consuming, poorly adhered to in routine practice, and very intensive for patients [4]. We assessed the feasibility of a topically applied NIR dye-labeled lectin for the detection of early neoplasia in BE in an ex vivo setting
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