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⁎3442 Role of high resolution endoscopic imaging using optical coherence tomography (oct) in patients with barrett's esophagus (be).
*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 autofluorescence 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 observation named SEFAS: a simultaneous endoscopic fluorescence analyzing system. 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 peroxidation 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 measurement. 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 analyzed distributions of tissue peroxidation. Distributions of autofluorescent substance were also observed. Moreover, autofluorescent substance was analyzed with HPLC. Results: The dicrofenac treatment increased mucosal 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 clarity, 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 significantly 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 motility at the gastroesophageal junction. Although microscopic structures such as esophageal glands and blood vessels in the submucosa were clearly visible 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 corresponds 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 technique may be needed to enable surveillance large mucosal areas.
VOLUME 51, NO. 4, PART 2, 2000
*3443 CYTOCOIL - MORE TISSUE WITH A NEW DEVICE FOR SAMPLING OF CYTOLOGIC MATERIAL. PRELIMINARY RESULTS 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 collected 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 diameter 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 segments (length 20 to 30 cm) of three different pigs were collected. The segments 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 content 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 cytologic examination. As a parameter for comparison of the quantity of tissue collected with various devices the protein content of the specimens was used. The newly designed CC collected eight times as much material as a conventional CB. Further studies are required to evaluate whether this considerable increase in the amount of tissue translates into higher sensitivity 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 qualitatively improve the capability of diagnosing lymph node swelling, contrastenhanced 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 gastrointestinal 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 nonhomogeneous 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 contrast, 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 CEEL were 92.8%, 95.5%, 92.8%, 95.5%, and 94.4%, respectively. CONCLUSION: The diagnostic capability is expected to be improved by combining CE-EL with EUS-FNAB. Therefore, the combination of CE-EL and EUSFNAB is considered a favorable examination method for differentially diagnosing swollen lymph nodes.
GASTROINTESTINAL ENDOSCOPY
AB93
VOLUME 51, NO. 4, PART 2, 2000
*3443 CYTOCOIL - MORE TISSUE WITH A NEW DEVICE FOR SAMPLING OF CYTOLOGIC MATERIAL. PRELIMINARY RESULTS 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 collected 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 diameter 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 segments (length 20 to 30 cm) of three different pigs were collected. The segments 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 content 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 cytologic examination. As a parameter for comparison of the quantity of tissue collected with various devices the protein content of the specimens was used. The newly designed CC collected eight times as much material as a conventional CB. Further studies are required to evaluate whether this considerable increase in the amount of tissue translates into higher sensitivity 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 qualitatively improve the capability of diagnosing lymph node swelling, contrastenhanced 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 gastrointestinal 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 nonhomogeneous 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 contrast, 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 CEEL were 92.8%, 95.5%, 92.8%, 95.5%, and 94.4%, respectively. CONCLUSION: The diagnostic capability is expected to be improved by combining CE-EL with EUS-FNAB. Therefore, the combination of CE-EL and EUSFNAB is considered a favorable examination method for differentially diagnosing swollen lymph nodes.
GASTROINTESTINAL ENDOSCOPY
AB93