- Email: [email protected]
⁎3447 Ultra-high magnification endoscopy for early stage esophageal cancer.
*3445 A CLINICAL STUDY OF THE USE OF ZOOM VIDEO ENDOSCOPY FOR THE MONITORING OF ACUTE REJECTION IN THE SMALL BOWEL ALLOGRAFT. Tomoaki Kato, Christopher B. O’Brien, Nishida Seigo, Mariana Berho, Antonio D. Pinna, Andreas G. Tzakis, Div of Transplantation, Univ of Miami, Miami, FL; Div of Hepatology, Univ of Miami, Miami, FL; Univ of Miami, Miami, FL. Purpose of the Study: To evaluate the efficacy of magnification endoscopy for the monitoring of acute rejection in small bowel transplant recipients. Patients & Methods: A zoom video endoscope (PentaxEC-3830LZ) was used in 15 intestinal transplant recipients during 166 endoscopy sessions. This endoscope has the capability to magnify the endoscopic view up to 100 fold. With the magnification, the entire length of villi and crypt areas can be observed. All procedures were performed through surgical created ostomy except for one patient who received the procedure vua rectum. Results: Eighty-seven (52%) biopsies taken during the zoom endoscopy sessions were read as acute rejection by histological criteria including mild (n=70), moderate (n=14) and severe (n=3) rejections. Specific zoom endoscopic findings noted to correlate with the histological diagnosis of rejection were enlarged crypt areas (n=19), villus blunting (n=39), and flattening of villi (n=3). Rejections were successfully treated on all but two occasions with these changes seen on the zoom endoscopy returning to normal appearance. On 31 occasions, histologically diagnosed mild rejections were not treated based on normal findings on zoom endoscopy. These histological rejections all reversed without treatment. There were no complications associated with endscopies or biopsies. Conclusions: Zoom video endoscopy could clearly visualized the microscopic architecture of small bowel graft mucosa enabling the recognition of specific mucosal changes of rejection. We feel that an ability to more accurately assess the small bowel graft mucosa by this form of endoscopy enabled more timely initiation of the treatment of rejection and prevented unnecessary immunosuppression.
*3447 ULTRA-HIGH MAGNIFICATION ENDOSCOPY FOR EARLY STAGE ESOPHAGEAL CANCER. Youichi Kumagai, Haruhiro Inoue, Tatuyuki Kawano, Tatuya Yoshida, Takehisa Iwai, 1st Dept of Surg, Tokyo Med and Dental Univ, Tokyo, Japan. For purpose of evaluating characteristic microstructure of the early-stage esophageal cancer, ultra-high magnification endoscopic examination was introduced as pretherapeutic in vivo study. Methods: Ultra-high magnification endoscopy (UHME, Q240Z, Olympus, Tokyo) can vary its magnifying rate from eight times to one hundred and fifty times. High-quality pictures can be constantly obtained by attaching a 2-mm depth soft distal attachment onto the tip of UHME. Results: Vascular architecture can be continuously visualized starting from submucosal vein through proper mucosal layer, configurating characteristic fine-vascular network pattern, to intrapapillary capillary loop (IPCL) in the epitherium, which can never be observed during traditional magnifying endoscopic examination with maximal thirty-five magnifications. 0-IIc lesion that was usually observed as a well demarcated red patch, are revealed to be a composite of scattered red dots and a pink homogenous background. Those red dots are disclosed to be changes of IPCL such as dilatation, weaving, irregularity of caliber, which are never observed in normal and esophagitis mucosa. Infiltration depth of the lesions was clearly demonstrated as elongation and destruction of IPCL. We observed one hundred and twelve cases, and overall accuracy was 75%. Conclusion: By utilizing UHME, authurs succeeded to disclose various novel knowledge of microstructure in early esophageal cancer. This information is essential to pre-therapeutic diagnosis.
*3446 USING A 15.3 FRENCH BIOPSY FORCEPS ALLOWS TO OBTAIN THE ANATOMOPATHOLOGICAL DIAGNOSIS OF UPPER GI LESIONS AFTER FAILURE USING A STANDARD, 7-FR, BIOPSY FORCEPS. Jean-Luc Van Laethem, Sebastien Debroux, Jean-Marc Dumonceau, Marie-Odile Peny, Myriam Remmelinck, Isabelle Salmon, Jacques Deviere, Erasme Hosp, Brussels, Belgium. Background and aim of the study : the diagnosis of malignancy in the upper GI tract may be difficult to determine at histological examination, especially if diffuse, infiltrative or submucosal lesions are sampled using a standard, 7-Fr, biopsy forceps. We report on the results obtained with a new, larger, biopsy forceps in patients with such lesions, of undefinite diagnosis at anatomopathological examination of biopsies obtained using a standard forceps. Patients and methods : between 11/97 and 10/99, 27 patients were assessed for this technique (13 men and 14 women ; mean age, 60 ± 14 years). All patients disclosed at upper GI endoscopy a lesion whose histological diagnosis remained indefinite after examination of standard biopsies (sampled using a 7-Fr forceps). Macrobiopsies were sampled using a 15.3-Fr forceps (FB-51K-1, Olympus, Hamburg, Germany) passed through the 6-mm working channel of a jumbo fiberoptic gastroscope (XT-30, Olympus). Diagnosis was confirmed by surgery or by adequate follow-up. Results : endoscopic examination disclosed mucosal ulcers or nodules in 15 patients, submucosal nodules or large polypoid lesions in 11 patients, as well as large ulcerated folds in the duodenum of 1 patient. No complication related to the sampling procedure was observed. Histological examination of macrobiopsies provided a definite diagnosis of malignancy in 14 patients (lymphoma, n=3 ; adenocarcinoma in Barrett’s esophagus, n=3 ; squamous epithelioma, n=1; linitis gastrica, n=4 ; carcinosarcoma, n=1 ; melanoma, n=1 ; metastasis, n=1), a diagnosis of benign submucosal tumour in 1 patient, and confirmed the absence of tumour in 9 others (by evidencing normal mucosa and submucosa). In 4 patients, including 2 leiomyoma, macrobiopsies failed to reveal the diagnosis. Submucosa was evidenced in macrobiospies from 27/27 (100%) patients, compared to standard biopsies from 6/27 (22%) patients (<0.001). Conclusions : the use of a 15.3 Fr biopsy forceps significantly increases the yield of histological diagnosis for lesions located in the upper GI tract, especially if these are infiltrative or located in the submucosa.
*3448 IN VIVO ENDOSCOPIC OPTICAL COHERENCE TOMOGRAPHY OF ESOPHAGITIS, BARRETT’S ESOPHAGUS, AND ADENOCARCINOMA OF THE ESOPHAGUS. Uwe Seitz, Univ Hosp Hamburg Eppendorf, Hamburg, Germany. Background and Aims Optical coherence tomography (OCT) is a cross-sectional imaging technique comparable to ultrasound. Using infrared light instead of ultrasound, the superficial 1-2mm of the intestinal wall can be scanned with a resolution of almost 10 µm. Endoscopic OCT in esophageal disorders, including Barrett’s esophagus was examined in this pilot study. Methods A portable OCT processor is connected to a probe (outer diameter of 2.7 mm) inserted through the working channel of the endoscope. Scanning is performed in prograde direction. Image acquisition time was 1.5 sec and the image is shown on a laptop computer. Mucosal architecture of patients with reflux esophagitis (n=9), Barrett’s esophagus (n=9), and Barrett’s related esophageal cancer (n=6) was examined with OCT and compared with histology of biopsies. Results From normal esophagus to Barrett carcinoma increasing edema, fibrinoid deposits, and loss of the epithelial layer were observed. OCT images allows for distinguishing normal esophagus (Fig.1), Barrett’s esophagus (Fig.2), reflux esophagitis, and carcinoma (Fig.3). In Barrett’s esophagus, a stratified structure of the mucosa was found that is different from squamous carcinoma . OCT of Barrett’s cancer showed loss of regular structure of the esophageal epithelium. The OCT system was easy to use and portable between endoscopy rooms. Conclusions The high consistency of optical coherence tomography findings, the resolution of up to 10 µm, and the distinct pattern of normal, inflammatory, premalignant and malignant tissues make OCT a promising method of “optical biopsy” in the esophagus. The ease of use allows for integration into routine diagnostic endoscopy.
AB94
GASTROINTESTINAL ENDOSCOPY
VOLUME 51, NO. 4, PART 2, 2000
*3447 ULTRA-HIGH MAGNIFICATION ENDOSCOPY FOR EARLY STAGE ESOPHAGEAL CANCER. Youichi Kumagai, Haruhiro Inoue, Tatuyuki Kawano, Tatuya Yoshida, Takehisa Iwai, 1st Dept of Surg, Tokyo Med and Dental Univ, Tokyo, Japan. For purpose of evaluating characteristic microstructure of the early-stage esophageal cancer, ultra-high magnification endoscopic examination was introduced as pretherapeutic in vivo study. Methods: Ultra-high magnification endoscopy (UHME, Q240Z, Olympus, Tokyo) can vary its magnifying rate from eight times to one hundred and fifty times. High-quality pictures can be constantly obtained by attaching a 2-mm depth soft distal attachment onto the tip of UHME. Results: Vascular architecture can be continuously visualized starting from submucosal vein through proper mucosal layer, configurating characteristic fine-vascular network pattern, to intrapapillary capillary loop (IPCL) in the epitherium, which can never be observed during traditional magnifying endoscopic examination with maximal thirty-five magnifications. 0-IIc lesion that was usually observed as a well demarcated red patch, are revealed to be a composite of scattered red dots and a pink homogenous background. Those red dots are disclosed to be changes of IPCL such as dilatation, weaving, irregularity of caliber, which are never observed in normal and esophagitis mucosa. Infiltration depth of the lesions was clearly demonstrated as elongation and destruction of IPCL. We observed one hundred and twelve cases, and overall accuracy was 75%. Conclusion: By utilizing UHME, authurs succeeded to disclose various novel knowledge of microstructure in early esophageal cancer. This information is essential to pre-therapeutic diagnosis.
*3446 USING A 15.3 FRENCH BIOPSY FORCEPS ALLOWS TO OBTAIN THE ANATOMOPATHOLOGICAL DIAGNOSIS OF UPPER GI LESIONS AFTER FAILURE USING A STANDARD, 7-FR, BIOPSY FORCEPS. Jean-Luc Van Laethem, Sebastien Debroux, Jean-Marc Dumonceau, Marie-Odile Peny, Myriam Remmelinck, Isabelle Salmon, Jacques Deviere, Erasme Hosp, Brussels, Belgium. Background and aim of the study : the diagnosis of malignancy in the upper GI tract may be difficult to determine at histological examination, especially if diffuse, infiltrative or submucosal lesions are sampled using a standard, 7-Fr, biopsy forceps. We report on the results obtained with a new, larger, biopsy forceps in patients with such lesions, of undefinite diagnosis at anatomopathological examination of biopsies obtained using a standard forceps. Patients and methods : between 11/97 and 10/99, 27 patients were assessed for this technique (13 men and 14 women ; mean age, 60 ± 14 years). All patients disclosed at upper GI endoscopy a lesion whose histological diagnosis remained indefinite after examination of standard biopsies (sampled using a 7-Fr forceps). Macrobiopsies were sampled using a 15.3-Fr forceps (FB-51K-1, Olympus, Hamburg, Germany) passed through the 6-mm working channel of a jumbo fiberoptic gastroscope (XT-30, Olympus). Diagnosis was confirmed by surgery or by adequate follow-up. Results : endoscopic examination disclosed mucosal ulcers or nodules in 15 patients, submucosal nodules or large polypoid lesions in 11 patients, as well as large ulcerated folds in the duodenum of 1 patient. No complication related to the sampling procedure was observed. Histological examination of macrobiopsies provided a definite diagnosis of malignancy in 14 patients (lymphoma, n=3 ; adenocarcinoma in Barrett’s esophagus, n=3 ; squamous epithelioma, n=1; linitis gastrica, n=4 ; carcinosarcoma, n=1 ; melanoma, n=1 ; metastasis, n=1), a diagnosis of benign submucosal tumour in 1 patient, and confirmed the absence of tumour in 9 others (by evidencing normal mucosa and submucosa). In 4 patients, including 2 leiomyoma, macrobiopsies failed to reveal the diagnosis. Submucosa was evidenced in macrobiospies from 27/27 (100%) patients, compared to standard biopsies from 6/27 (22%) patients (<0.001). Conclusions : the use of a 15.3 Fr biopsy forceps significantly increases the yield of histological diagnosis for lesions located in the upper GI tract, especially if these are infiltrative or located in the submucosa.
*3448 IN VIVO ENDOSCOPIC OPTICAL COHERENCE TOMOGRAPHY OF ESOPHAGITIS, BARRETT’S ESOPHAGUS, AND ADENOCARCINOMA OF THE ESOPHAGUS. Uwe Seitz, Univ Hosp Hamburg Eppendorf, Hamburg, Germany. Background and Aims Optical coherence tomography (OCT) is a cross-sectional imaging technique comparable to ultrasound. Using infrared light instead of ultrasound, the superficial 1-2mm of the intestinal wall can be scanned with a resolution of almost 10 µm. Endoscopic OCT in esophageal disorders, including Barrett’s esophagus was examined in this pilot study. Methods A portable OCT processor is connected to a probe (outer diameter of 2.7 mm) inserted through the working channel of the endoscope. Scanning is performed in prograde direction. Image acquisition time was 1.5 sec and the image is shown on a laptop computer. Mucosal architecture of patients with reflux esophagitis (n=9), Barrett’s esophagus (n=9), and Barrett’s related esophageal cancer (n=6) was examined with OCT and compared with histology of biopsies. Results From normal esophagus to Barrett carcinoma increasing edema, fibrinoid deposits, and loss of the epithelial layer were observed. OCT images allows for distinguishing normal esophagus (Fig.1), Barrett’s esophagus (Fig.2), reflux esophagitis, and carcinoma (Fig.3). In Barrett’s esophagus, a stratified structure of the mucosa was found that is different from squamous carcinoma . OCT of Barrett’s cancer showed loss of regular structure of the esophageal epithelium. The OCT system was easy to use and portable between endoscopy rooms. Conclusions The high consistency of optical coherence tomography findings, the resolution of up to 10 µm, and the distinct pattern of normal, inflammatory, premalignant and malignant tissues make OCT a promising method of “optical biopsy” in the esophagus. The ease of use allows for integration into routine diagnostic endoscopy.
AB94
GASTROINTESTINAL ENDOSCOPY
VOLUME 51, NO. 4, PART 2, 2000