High-resolution imaging in Barrett's esophagus: a novel, low-cost endoscopic microscope

Background: This report describes the clinical evaluation of a novel, low-cost, high-resolution endoscopic microscope for obtaining fluorescent images of the cellular morphology of the epithelium of regions of the esophagus with Barrett's metaplasia. This noninvasive point imaging system offers a method for obtaining real-time histologic information during endoscopy. Objective: The objective of this study was to compare images taken with the fiberoptic endoscopic microscope with standard histopathologic examination. Design: Feasibility study. Setting: The University of Texas M. D. Anderson Cancer center Department of Gastroenterology. Patients, Interventions, and Main Outcome Measurements: The tissue samples studied in this report were obtained by endoscopic resection from patients with previous diagnoses of either high-grade dysplasia or esophageal adenocarcenoma. Results: Three distinct tissue types were observed ex vivo with the endoscopic microscope: normal squamous mucosa. Barrett s metaplasia, and high-grade dysplasia. Squamous tissue was identified by bright nuclei surrounded by dark cytoplasm in an ordered pattern. Barrett's metaplasia could be identified by large glandular structures with intact nuclear polarity. High-grade dysplasia was visualized as plentiful, irregular glandular structures and loss of nuclear polarity. Standard histopathologic examination of study samples confirmed the results obtained by the endoscopic microscope. Limitations: The endosopic microscope probe had to be placed into direct contact with tissue. Conclusion: It was feasible to obtain high-resolution histopathologic information using the endoscopic microscope device. Future improvement and integration with widefield endoscopic techniques will aid in improving the sensitivity of detection of dysplasia and early cancer development in the esophagus.