3442 Role of high resolution endoscopic imaging using optical coherence tomography (oct) in patients...
1
*3441 AUTOFLUORESCENCE AND TISSUE PEROXIDATION IN NSAIDS-INDUCED ACUTE GASTRIC MUCOSAL LESIONS IN HUMAN VOLUNTEERS. Itoe Makino, Hirofumi Matsui, Yasushi Murata, Iruru Nakamori, Akira Nakahara, Akinori Yanaka, Naomi Tanaka, Institutre of Clin Medicine, Univ of Tsukuba, Tsukuba, Japan. Background and Aims: We have already reported that gastric mucosal aut- ofluorescence intensity increased in accordance with gastric mucosal lesions formation induced by dicrofenac sodium administration in rats. In this study, we have established an endoscopic apparatus composed with an image processor and a highly-sensitive camera for fluorescence observa- tion named SEFAS: a simultaneous endoscopic fluorescence analyzing sys- tem. Using this system, we clarified whether NSAID-treatment increased gastric mucosal fluorescence intensity in human volunteers or not. Moreover, we examined relations of distributions between tissue peroxida- tion and fluorescent substance. Methods: Healthy human volunteers who completely agreed to take part in this study were administrated 50 mg dicrofenac per os. Mucosal fluorescence intensity were measured with SEFAS before and 1, 2 hour(s) after the dicrofenac treatment. Moreover, volunteers were also administrated 50 mg teprenone, a mucosal prostaglandin inducing agent, 30 min before the dicrofenac treatment, and were also measured mucosal intensities. In each study, some pieces of mucosa were taken from each area of the mucosal fluorescence measure- ment. These biopsies were rapidly made into specimens of cryosections. They were immunohistochemicaly stained with anti-4-hydroxynonenal antibody, a specific monoclonal antibody for peroxidized tissue, and ana- lyzed distributions of tissue peroxidation. Distributions of autofluorescent substance were also observed. Moreover, autofluorescent substance was analyzed with HPLC. Results: The dicrofenac treatment increased mucos- al fluorescence intensity. The administrations of teprenone completely restrained this phenomenon. Fluorescence substances were porphyrins. These fluorescence substances were localized at the disrupted surface layer of the gastric mucosa. Peroxidized tissue was located in middle part of the mucosa. Conclusions: It suggested that tissue peroxidation was induced before mucosal injury formation, and fluorescent porphyrins were generated with tissue disruption. Mucosal fluorescence observations with SEFAS can diagnose NSAID-induced gastric lesions. *3442 ROLE OF HIGH RESOLUTION ENDOSCOPIC IMAGING USING OPTICAL COHERENCE TOMOGRAPHY (OCT) IN PATIENTS WITH BARRETT’S ESOPHAGUS (BE). A. Das, M. V. Sivak Jr., A. Chak, R. Ck Wong, V. Westphal, A. M. Rollins, J. Izatt, G. A. Isenberg, J. Willis, Univ Hospitals of Cleveland, Cleveland, OH; Case Western Reserve Univ, Cleveland, OH. OCT, a novel technique for high resolution endoscopic imaging clearly delineates microscopic mucosal and submucosal structures of the GI tract. Aim: To study the ability of OCT to identify and characterize BE. Methods: OCT images were obtained using an endoscopic OCT probe (2.4 mm dia, 0.5 mm focal distance)in patients undergoing surveillance EGD for BE. Images were captured digitally and were objectively rated in terms of clar- ity, resolution, ease of identification of BE and to determine whether areas of dysplasia could be identified. Four quadrant large particle biopsies were taken from the area of BE at 2 cm intervals and were correlated with OCT images. Results:8 patients with BE (mean age 62.5 years, 6 men) were studied. Mean length of BE was 7.7 (SE 2.2) cms; 3 patients had focal areas of high grade dysplasia. During OCT imaging squamous epithelium and Barrett’s epithelium could be readily distinguished. Also, areas with Barrett’s epithelium lacked the characteristic thick, dark band which is seen with stratified squamous epithelium. The esophageal mucosa was sig- nificantly thicker in the areas of Barrett’s epithelium (mean thickness 0.6 mm vs. 0.4 mm, p < 0.01) compared to areas of squamous epithelium. The squamo-columnar transition zone could be readily discerned in all except one; in this patient difficulty was experienced in correctly positioning the OCT probe due to short length of Barrett’s epithelium and excessive motil- ity at the gastroesophageal junction. Although microscopic structures such as esophageal glands and blood vessels in the submucosa were clearly vis- ible in the OCT images, areas of dysplasia were not identified. Due to the small diameter of the OCT probe relative to the lumen, it is difficult to fully image a mucosal abnormality that has a large surface area. Conclusion: During OCT imaging of BE, histological details that corre- sponds to columnar changes and intestinal metaplasia were clearly seen. However, at current resolution dysplastic changes associated with BE may not be detectable. Further advances in probe technology and OCT tech- nique may be needed to enable surveillance large mucosal areas. *3443 CYTOCOIL - MORE TISSUE WITH A NEW DEVICE FOR SAMPLING OF CYTOLOGIC MATERIAL. PRELIMINARY RE- SULTS OF APPLICATION. Eckart Frimberger, Philipp Becker, Thomas Roesch, Meinhard Classen, Dept of Internal Medicine II,Tech Univ, Munich, Germany. Background: The amount of material obtained with the cytology brush (CB) is limited which restricts the sensitivity of cytologic examinations. In order to augment the quantity of tissue a new instrument, CytoCoil (CC), was designed. In a comparison of the amount of tissue obtained with CC versus CB, we quantified the relative protein content of the specimens col- lected with both devices. Material and Methods: CC consists of a spiral made of flat wire at the distal end of a plastic catheter. The external diam- eter of the coil is 2.2mm, and its length 36 mm (Braun Melsungen, Germany). As CB we used a conventional brush with a diameter of 3mm and a length of 11mm (Microvasive, Boston Scientific). Pairs of specimens (taken either with CC or with CB in random order) from 15 colonic seg- ments (length 20 to 30 cm) of three different pigs were collected. The seg- ments had been attached to a laparoscopy simulator. The material was obtained within a maximum of 30 min after the colon was removed from the sacrificed animal. The samples were processed using CytoLyt Solution (Boxborough, MA) as a transport medium and washing agent to lyse blood, dissolve mucus, and remove extracellular protein. The relative quantity of tissue of each specimen was evaluated by the colorimetric measurement of the protein concentration according to the Lowry assay. Results: Material was obtained at each application of the devices. In each pair of specimens, CC delivered a higher amount of protein than CB. The average protein con- tent of the cytologic material collected by CC and CB was 771 μg (SD 367) and 98 μg (SD 51), respectively (p < 0,0001). No perforations of the bowel were observed. Discussion: It is assumed that the diagnostic sensitivity of cytology correlates positively to the quantity of tissue obtained for cytolog- ic examination. As a parameter for comparison of the quantity of tissue col- lected with various devices the protein content of the specimens was used. The newly designed CC collected eight times as much material as a con- ventional CB. Further studies are required to evaluate whether this con- siderable increase in the amount of tissue translates into higher sensitivi- ty and specificity of cytologic examinations. *3444 USEFULNESS OF CONTRAST ECHOLYMPHOGRAPHY USING ENDOSCOPIC ULTRASONOGRAPHY-GUIDED PUNCTURE. Shinya Kojima, Yoshiki Hirooka, Akihiro Itoh, Yoshihiro Ishiguro, Senju Hashimoto, Takanori Hirai, Tetsuo Hayakawa, Hidemi Goto, Yasuo Naitoh, Nagoya Univ Sch of Medicine, Nagoya, Japan. BACKGROUND: The accuracy of EUS in the assessment of regional lymph node metastasis leaves to be desired. Although EUS-guided fine needle aspiration biopsy (EUS-FNAB). is a superior examination method, there are various problems, such as difficulty in collecting tissue specimens and collection of tissue specimens from noncancerous regions. AIM: To qualita- tively improve the capability of diagnosing lymph node swelling, contrast- enhanced echolymphography (CE-EL) was performed using EUS-guided puncture. SUBJECTS AND METHOD : In the present study, 8 malignant swollen lymph nodes surgically resected from patients with gastrointesti- nal cancers and 36 lymph nodes obtained from 36 patients in whom abdominal lymph node swelling was indicated by EUS (14 cases of metastatic lymph node swelling and 22 cases of benign lymph node swelling) were examined. Lymph nodes were punctured under real-time EUS guidance, and carbon dioxide microbubbles were topically injected to evaluate ultrasonograms before and after microbubble injection. RESULTS: CE-EL of freshly resected metastatic lymph nodes showed non- homogeneous patterns. Resions in the lymph node demonstrating filling defects during CE-EL were pathologically correlated with resions showing neoplastic infiltration. When the results of EUS performed before CE-EL were clinically evaluated, there were no apparent differences in any echo features except the shape of lymph nodes between the malignant and benign groups (malignant lymph nodes showed rounded shapes). In con- trast, CE-EL demonstrated nonhomogeneous patterns, poor distribution of contrast medium, and filling defects in 92.9 to 100% of subjects in the malignant group. However, CE-EL demonstrated uniform patterns in 68.2% of subjects in the benign group. Therefore, there were differences in CE-EL findings between the two groups.The sensitivity, specificity, rate of positivity and negativity, and accuracy of differentiation diagnosis by CE- EL were 92.8%, 95.5%, 92.8%, 95.5%, and 94.4%, respectively. CONCLU- SION: The diagnostic capability is expected to be improved by combining CE-EL with EUS-FNAB. Therefore, the combination of CE-EL and EUS- FNAB is considered a favorable examination method for differentially diagnosing swollen lymph nodes. VOLUME 51, NO. 4, PART 2, 2000 GASTROINTESTINAL ENDOSCOPY AB93
Transcript of 3442 Role of high resolution endoscopic imaging using optical coherence tomography (oct) in patients...
*3441AUTOFLUORESCENCE AND TISSUE PEROXIDATION INNSAIDS-INDUCED ACUTE GASTRIC MUCOSAL LESIONS INHUMAN VOLUNTEERS.Itoe Makino, Hirofumi Matsui, Yasushi Murata, Iruru Nakamori, AkiraNakahara, Akinori Yanaka, Naomi Tanaka, Institutre of Clin Medicine,Univ of Tsukuba, Tsukuba, Japan.Background and Aims: We have already reported that gastric mucosal aut-ofluorescence intensity increased in accordance with gastric mucosallesions formation induced by dicrofenac sodium administration in rats. Inthis study, we have established an endoscopic apparatus composed with animage processor and a highly-sensitive camera for fluorescence observa-tion named SEFAS: a simultaneous endoscopic fluorescence analyzing sys-tem. Using this system, we clarified whether NSAID-treatment increasedgastric mucosal fluorescence intensity in human volunteers or not.Moreover, we examined relations of distributions between tissue peroxida-tion and fluorescent substance. Methods: Healthy human volunteers whocompletely agreed to take part in this study were administrated 50 mgdicrofenac per os. Mucosal fluorescence intensity were measured withSEFAS before and 1, 2 hour(s) after the dicrofenac treatment. Moreover,volunteers were also administrated 50 mg teprenone, a mucosalprostaglandin inducing agent, 30 min before the dicrofenac treatment, andwere also measured mucosal intensities. In each study, some pieces ofmucosa were taken from each area of the mucosal fluorescence measure-ment. These biopsies were rapidly made into specimens of cryosections.They were immunohistochemicaly stained with anti-4-hydroxynonenalantibody, a specific monoclonal antibody for peroxidized tissue, and ana-lyzed distributions of tissue peroxidation. Distributions of autofluorescentsubstance were also observed. Moreover, autofluorescent substance wasanalyzed with HPLC. Results: The dicrofenac treatment increased mucos-al fluorescence intensity. The administrations of teprenone completelyrestrained this phenomenon. Fluorescence substances were porphyrins.These fluorescence substances were localized at the disrupted surfacelayer of the gastric mucosa. Peroxidized tissue was located in middle partof the mucosa. Conclusions: It suggested that tissue peroxidation wasinduced before mucosal injury formation, and fluorescent porphyrins weregenerated with tissue disruption. Mucosal fluorescence observations withSEFAS can diagnose NSAID-induced gastric lesions.
*3442ROLE OF HIGH RESOLUTION ENDOSCOPIC IMAGING USINGOPTICAL COHERENCE TOMOGRAPHY (OCT) IN PATIENTSWITH BARRETT’S ESOPHAGUS (BE).A. Das, M. V. Sivak Jr., A. Chak, R. Ck Wong, V. Westphal, A. M. Rollins, J.Izatt, G. A. Isenberg, J. Willis, Univ Hospitals of Cleveland, Cleveland, OH;Case Western Reserve Univ, Cleveland, OH.OCT, a novel technique for high resolution endoscopic imaging clearlydelineates microscopic mucosal and submucosal structures of the GI tract.Aim: To study the ability of OCT to identify and characterize BE. Methods:OCT images were obtained using an endoscopic OCT probe (2.4 mm dia,0.5 mm focal distance)in patients undergoing surveillance EGD for BE.Images were captured digitally and were objectively rated in terms of clar-ity, resolution, ease of identification of BE and to determine whether areasof dysplasia could be identified. Four quadrant large particle biopsies weretaken from the area of BE at 2 cm intervals and were correlated with OCTimages. Results:8 patients with BE (mean age 62.5 years, 6 men) werestudied. Mean length of BE was 7.7 (SE 2.2) cms; 3 patients had focal areasof high grade dysplasia. During OCT imaging squamous epithelium andBarrett’s epithelium could be readily distinguished. Also, areas withBarrett’s epithelium lacked the characteristic thick, dark band which isseen with stratified squamous epithelium. The esophageal mucosa was sig-nificantly thicker in the areas of Barrett’s epithelium (mean thickness 0.6mm vs. 0.4 mm, p < 0.01) compared to areas of squamous epithelium. Thesquamo-columnar transition zone could be readily discerned in all exceptone; in this patient difficulty was experienced in correctly positioning theOCT probe due to short length of Barrett’s epithelium and excessive motil-ity at the gastroesophageal junction. Although microscopic structures suchas esophageal glands and blood vessels in the submucosa were clearly vis-ible in the OCT images, areas of dysplasia were not identified. Due to thesmall diameter of the OCT probe relative to the lumen, it is difficult tofully image a mucosal abnormality that has a large surface area.Conclusion: During OCT imaging of BE, histological details that corre-sponds to columnar changes and intestinal metaplasia were clearly seen.However, at current resolution dysplastic changes associated with BE maynot be detectable. Further advances in probe technology and OCT tech-nique may be needed to enable surveillance large mucosal areas.
*3443CYTOCOIL - MORE TISSUE WITH A NEW DEVICE FORSAMPLING OF CYTOLOGIC MATERIAL. PRELIMINARY RE-SULTS OF APPLICATION.Eckart Frimberger, Philipp Becker, Thomas Roesch, Meinhard Classen,Dept of Internal Medicine II, Tech Univ, Munich, Germany.Background: The amount of material obtained with the cytology brush(CB) is limited which restricts the sensitivity of cytologic examinations. Inorder to augment the quantity of tissue a new instrument, CytoCoil (CC),was designed. In a comparison of the amount of tissue obtained with CCversus CB, we quantified the relative protein content of the specimens col-lected with both devices. Material and Methods: CC consists of a spiralmade of flat wire at the distal end of a plastic catheter. The external diam-eter of the coil is 2.2mm, and its length 36 mm (Braun Melsungen,Germany). As CB we used a conventional brush with a diameter of 3mmand a length of 11mm (Microvasive, Boston Scientific). Pairs of specimens(taken either with CC or with CB in random order) from 15 colonic seg-ments (length 20 to 30 cm) of three different pigs were collected. The seg-ments had been attached to a laparoscopy simulator. The material wasobtained within a maximum of 30 min after the colon was removed fromthe sacrificed animal. The samples were processed using CytoLyt Solution(Boxborough, MA) as a transport medium and washing agent to lyse blood,dissolve mucus, and remove extracellular protein. The relative quantity oftissue of each specimen was evaluated by the colorimetric measurement ofthe protein concentration according to the Lowry assay. Results: Materialwas obtained at each application of the devices. In each pair of specimens,CC delivered a higher amount of protein than CB. The average protein con-tent of the cytologic material collected by CC and CB was 771 µg (SD 367)and 98 µg (SD 51), respectively (p < 0,0001). No perforations of the bowelwere observed. Discussion: It is assumed that the diagnostic sensitivity ofcytology correlates positively to the quantity of tissue obtained for cytolog-ic examination. As a parameter for comparison of the quantity of tissue col-lected with various devices the protein content of the specimens was used.The newly designed CC collected eight times as much material as a con-ventional CB. Further studies are required to evaluate whether this con-siderable increase in the amount of tissue translates into higher sensitivi-ty and specificity of cytologic examinations.
*3444USEFULNESS OF CONTRAST ECHOLYMPHOGRAPHY USINGENDOSCOPIC ULTRASONOGRAPHY-GUIDED PUNCTURE.Shinya Kojima, Yoshiki Hirooka, Akihiro Itoh, Yoshihiro Ishiguro, SenjuHashimoto, Takanori Hirai, Tetsuo Hayakawa, Hidemi Goto, Yasuo Naitoh,Nagoya Univ Sch of Medicine, Nagoya, Japan.BACKGROUND: The accuracy of EUS in the assessment of regional lymphnode metastasis leaves to be desired. Although EUS-guided fine needleaspiration biopsy (EUS-FNAB). is a superior examination method, thereare various problems, such as difficulty in collecting tissue specimens andcollection of tissue specimens from noncancerous regions. AIM: To qualita-tively improve the capability of diagnosing lymph node swelling, contrast-enhanced echolymphography (CE-EL) was performed using EUS-guidedpuncture. SUBJECTS AND METHOD : In the present study, 8 malignantswollen lymph nodes surgically resected from patients with gastrointesti-nal cancers and 36 lymph nodes obtained from 36 patients in whomabdominal lymph node swelling was indicated by EUS (14 cases ofmetastatic lymph node swelling and 22 cases of benign lymph nodeswelling) were examined. Lymph nodes were punctured under real-timeEUS guidance, and carbon dioxide microbubbles were topically injected toevaluate ultrasonograms before and after microbubble injection.RESULTS: CE-EL of freshly resected metastatic lymph nodes showed non-homogeneous patterns. Resions in the lymph node demonstrating fillingdefects during CE-EL were pathologically correlated with resions showingneoplastic infiltration. When the results of EUS performed before CE-ELwere clinically evaluated, there were no apparent differences in any echofeatures except the shape of lymph nodes between the malignant andbenign groups (malignant lymph nodes showed rounded shapes). In con-trast, CE-EL demonstrated nonhomogeneous patterns, poor distribution ofcontrast medium, and filling defects in 92.9 to 100% of subjects in themalignant group. However, CE-EL demonstrated uniform patterns in68.2% of subjects in the benign group. Therefore, there were differences inCE-EL findings between the two groups. The sensitivity, specificity, rate ofpositivity and negativity, and accuracy of differentiation diagnosis by CE-EL were 92.8%, 95.5%, 92.8%, 95.5%, and 94.4%, respectively. CONCLU-SION: The diagnostic capability is expected to be improved by combiningCE-EL with EUS-FNAB. Therefore, the combination of CE-EL and EUS-FNAB is considered a favorable examination method for differentiallydiagnosing swollen lymph nodes.
VOLUME 51, NO. 4, PART 2, 2000 GASTROINTESTINAL ENDOSCOPY AB93
