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Mo1994 Ultrahigh Resolution Endoscopic Optical Coherence Tomography at 800 nm for Imaging of Bile Duct
Abstracts
prophylactic antibiotics. Patients later underwent radiation simulation and therapy. Results: Two patients underwent liquid fiducial injections successfully. First patient, 80 year old woman with a 28 by 17 mm mass in the head of the pancreas with a total injection of 1.6 cc of hydrogel. Second patient, 87 year old woman with a 23 by 22 mm mass in the body of the pancreas with a total of 5.1 cc of hydrogel administered. The hydrogel was clearly visualized during EUS with a hyperechoic echogenicity. Both patients had mild epigastric discomfort after the procedure, but no major complications were encountered. Radiation simulation, including motion studies were performed. Onboard imaging during radiation treatment with cone beam CT visualized the implanted hydrogel marker allowing real time registration of images and accurate targeting of the tumor. Conclusion: EUS-guided delivery of a new liquid fiducial into pancreatic cancer is feasible and provides adequate visualization of the marker during EUS-guided administration and during mapping and image guidance for stereotactic radiotherapy. Further studies are necessary to assess long-term outcomes, safety, and to compare this liquid fiducial to standard metal fiducials.
Mo1993 Improved Visibility of Early Gastric Cancer Using Linked Color Imaging Compared With Blue Laser Imaging Yoshikazu Yoshifuku*1, Yoji Sanomura1, Shiro Oka1, Mio Kurihara2, Takeshi Mizumoto2, Tomohiro Miwata2, Yuji Urabe2, Toru Hiyama3, Shinji Tanaka1, Kazuaki Chayama2 1 Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan; 3Health Service Center, Hiroshima University, Higashihiroshima, Japan Background: Diagnosis of early gastric cancer (EGC) at an early stage is very important to obtain good prognosis. However, early diagnosis of EGC with white-light endoscopic observation alone is sometimes difficult. Currently, various imageenhanced endoscopy (IEE) such as narrow-band imaging and blue laser imaging (BLI) has been developed, and there were several reports to prove usefulness of IEE for EGC. In 2015, linked color imaging (LCI) which is the color enhancement feature for LASEREO systems (FUJIFILM, Co, Tokyo, Japan) has been developed, and make it easy to recognize the slight difference in mucosal color. Because contrast of color between tumor and surround mucosa is enhanced using LCI, reddish tumor becomes redder, whitish tumor becomes whiter. Thus, visibility of tumor should be improved compared with white light imaging (WLI). However, there are no detailed reports about visibility improvement of EGC using LCI. Object: The aim of this study was to evaluate change of visibility for EGC using LCI compared with WLI and BLI. Patients and Methods: We included 82 EGCs in consecutive 82 patients who were observed with LCI and underwent endoscopic submucosal dissection (ESD) at Hiroshima University Hospital between April 2014 and August 2015. Five experienced physicians compared LCI image and BLI image with WLI. These images were taken from the same distance, and the same angle. Physicians scored each of the LCI and BLI images for visibility of tumors according to the following scale: +2 (improved visibility), +1 (somewhat improved visibility), 0 (visibility equivalent to that of WLI), –1 (some what worsened visibility), and –2 (worsened visibility). If an image earned a total score of +5 or more, the image was considered improved, a score between +4 and –4 indicated equivalent, and a score of –5 or less indicated worsened visibility. We also examined interobserver agreement in relation to the evaluation of the LCI and BLI images. Results: Visibility improvement with LCI and BLI for EGC was seen in 73% (60/82) and 20% (16/82). There was a significantly higher improvement with LCI than that with BLI (p<0.01). As for tumor color with WLI, visibility improvement with LCI of reddish and whitish tumor was significantly higher than that of isochromatic tumor. Visibility improvement with LCI in patients eradicated Helicobacter pylori (Hp) and not eradicated was seen in 71% (12/17) and 74% (48/65). There was no significant difference between the two groups. However, it was high visibility improvement rate even in patients eradicated Hp. Interobserver agreement was good to satisfactory at 0.52 or higher. Conclusion: LCI improved image quality of EGCs regardless of Hp eradication, especially for EGCs with reddish or whitish color.
Mo1994 Ultrahigh Resolution Endoscopic Optical Coherence Tomography at 800 nm for Imaging of Bile Duct Wu Yuan*1, Jessica Mavadia-Shukla1, Saowanee Ngamruengphong2, Kathleen L. Gabrielson3, Anthony N. Kalloo2, Xingde Li1 1 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD; 2Department of Medicine-Gastroenterology, Johns Hopkins University, Baltimore, MD; 3Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD Background: Optical coherence tomography (OCT) is capable of high resolution, in vivo, cross-sectional imaging of tissue anatomy. Endoscopic OCT has been used to image the biliary ductal system in vivo. However, it’s utility for investigating the pathology of bile duct in patients has been limited by resolution. Furthermore,
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reaching the biliary duct endoscopically entails advancing the duodenoscope through multiple sharp bends of the duodenum, requiring a flexible catheter with small profile for smooth proximal rotation or alternatively a distally actuated probe. Recently, our group has developed a second generation ultrahigh resolution endoscopes for OCT at 800 nm with improved contrast. In this study, we report volumetric imaging of bile duct ex vivo acquired with both proximal-scanning and distalscanning probes. The ultrahigh resolution endoscopic OCT images correlated with histology and demonstrated the potential for future duodenoscope-guided in vivo study of biliary duct pathology. Methods: The ultrahigh resolution endoscopic OCT system can achieve an axial resolution of w2.4 mm (compared to w10 mm in previous OCT studies). The microprobe and distal-scanning probe had an outer diameter of w1 mm and w1.8 mm (with protective plastic sheaths), respectively, which were small enough to pass through the accessory port of duodenoscope. A customized ball-lens and diffractive lens was implemented in the distal optics designs for the microprobe and distal-scanning probe, respectively, compensating the severe chromatic aberration incurred from the broad spectral bandwidth at 800nm. Fig. 1 (A) and (B) are photographs of the microprobe and distal-scanning probes, respectively. The microprobe consisted of a home-made fiber ball lens (as shown in inset of (A)) protected with a hypodermic tube. In conjunction with a home-made capillary tube-based rotary joint, the microprobe can rotate at a speed up to 35 revolutions/sec. The distal scanning endoscope consisted of a compound lens, custom diffractive element and miniature micromotor. It can rotate at a speed up to 100 revolutions/sec. The entire assembly was housed within a custom laser cut enclosure. Results: The representative ultrahigh resolution OCT images of swine bile duct shown in Fig.1. (C) and (D) were acquired with microprobe and distal-scanning probe, respectively. Biliary ductal structure such as submucosal glands, muscle layer and serosa were clearly observed and well correlated with histology displayed in Fig.1 (E) and (F). Conclusions: This study demonstrates ultrahigh resolution endoscopic OCT at 800 nm with super-achromatic microprobe and distal-scanning probe for imaging swine bile duct ex vivo. Further studies in ex vivo human bile duct is underway. Acknowledgment: We are grateful for the supports from the Wallace H. Coulter Foundation and the NIH (R01 HL121788).
Figure 1. (A) Photograph of microprobe which consists of a fiber balllens in the 25 gauge protective tube, inset: zoomed-in view of fiber balllens. (B) Distal-scanning probe. (C) and (D), representative ultrahigh resolution OCT images of swine bile duct acquired with microprobe and distal-scanning probe, respectively. (E) Corresponding H&E stained histology of bile duct. (F) Zoomed-in view of black boxed area of (E). M: muscularis, S: serosa, G: glands.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB487
prophylactic antibiotics. Patients later underwent radiation simulation and therapy. Results: Two patients underwent liquid fiducial injections successfully. First patient, 80 year old woman with a 28 by 17 mm mass in the head of the pancreas with a total injection of 1.6 cc of hydrogel. Second patient, 87 year old woman with a 23 by 22 mm mass in the body of the pancreas with a total of 5.1 cc of hydrogel administered. The hydrogel was clearly visualized during EUS with a hyperechoic echogenicity. Both patients had mild epigastric discomfort after the procedure, but no major complications were encountered. Radiation simulation, including motion studies were performed. Onboard imaging during radiation treatment with cone beam CT visualized the implanted hydrogel marker allowing real time registration of images and accurate targeting of the tumor. Conclusion: EUS-guided delivery of a new liquid fiducial into pancreatic cancer is feasible and provides adequate visualization of the marker during EUS-guided administration and during mapping and image guidance for stereotactic radiotherapy. Further studies are necessary to assess long-term outcomes, safety, and to compare this liquid fiducial to standard metal fiducials.
Mo1993 Improved Visibility of Early Gastric Cancer Using Linked Color Imaging Compared With Blue Laser Imaging Yoshikazu Yoshifuku*1, Yoji Sanomura1, Shiro Oka1, Mio Kurihara2, Takeshi Mizumoto2, Tomohiro Miwata2, Yuji Urabe2, Toru Hiyama3, Shinji Tanaka1, Kazuaki Chayama2 1 Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan; 2Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan; 3Health Service Center, Hiroshima University, Higashihiroshima, Japan Background: Diagnosis of early gastric cancer (EGC) at an early stage is very important to obtain good prognosis. However, early diagnosis of EGC with white-light endoscopic observation alone is sometimes difficult. Currently, various imageenhanced endoscopy (IEE) such as narrow-band imaging and blue laser imaging (BLI) has been developed, and there were several reports to prove usefulness of IEE for EGC. In 2015, linked color imaging (LCI) which is the color enhancement feature for LASEREO systems (FUJIFILM, Co, Tokyo, Japan) has been developed, and make it easy to recognize the slight difference in mucosal color. Because contrast of color between tumor and surround mucosa is enhanced using LCI, reddish tumor becomes redder, whitish tumor becomes whiter. Thus, visibility of tumor should be improved compared with white light imaging (WLI). However, there are no detailed reports about visibility improvement of EGC using LCI. Object: The aim of this study was to evaluate change of visibility for EGC using LCI compared with WLI and BLI. Patients and Methods: We included 82 EGCs in consecutive 82 patients who were observed with LCI and underwent endoscopic submucosal dissection (ESD) at Hiroshima University Hospital between April 2014 and August 2015. Five experienced physicians compared LCI image and BLI image with WLI. These images were taken from the same distance, and the same angle. Physicians scored each of the LCI and BLI images for visibility of tumors according to the following scale: +2 (improved visibility), +1 (somewhat improved visibility), 0 (visibility equivalent to that of WLI), –1 (some what worsened visibility), and –2 (worsened visibility). If an image earned a total score of +5 or more, the image was considered improved, a score between +4 and –4 indicated equivalent, and a score of –5 or less indicated worsened visibility. We also examined interobserver agreement in relation to the evaluation of the LCI and BLI images. Results: Visibility improvement with LCI and BLI for EGC was seen in 73% (60/82) and 20% (16/82). There was a significantly higher improvement with LCI than that with BLI (p<0.01). As for tumor color with WLI, visibility improvement with LCI of reddish and whitish tumor was significantly higher than that of isochromatic tumor. Visibility improvement with LCI in patients eradicated Helicobacter pylori (Hp) and not eradicated was seen in 71% (12/17) and 74% (48/65). There was no significant difference between the two groups. However, it was high visibility improvement rate even in patients eradicated Hp. Interobserver agreement was good to satisfactory at 0.52 or higher. Conclusion: LCI improved image quality of EGCs regardless of Hp eradication, especially for EGCs with reddish or whitish color.
Mo1994 Ultrahigh Resolution Endoscopic Optical Coherence Tomography at 800 nm for Imaging of Bile Duct Wu Yuan*1, Jessica Mavadia-Shukla1, Saowanee Ngamruengphong2, Kathleen L. Gabrielson3, Anthony N. Kalloo2, Xingde Li1 1 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD; 2Department of Medicine-Gastroenterology, Johns Hopkins University, Baltimore, MD; 3Department of Molecular and Comparative Pathobiology, Johns Hopkins University, Baltimore, MD Background: Optical coherence tomography (OCT) is capable of high resolution, in vivo, cross-sectional imaging of tissue anatomy. Endoscopic OCT has been used to image the biliary ductal system in vivo. However, it’s utility for investigating the pathology of bile duct in patients has been limited by resolution. Furthermore,
www.giejournal.org
reaching the biliary duct endoscopically entails advancing the duodenoscope through multiple sharp bends of the duodenum, requiring a flexible catheter with small profile for smooth proximal rotation or alternatively a distally actuated probe. Recently, our group has developed a second generation ultrahigh resolution endoscopes for OCT at 800 nm with improved contrast. In this study, we report volumetric imaging of bile duct ex vivo acquired with both proximal-scanning and distalscanning probes. The ultrahigh resolution endoscopic OCT images correlated with histology and demonstrated the potential for future duodenoscope-guided in vivo study of biliary duct pathology. Methods: The ultrahigh resolution endoscopic OCT system can achieve an axial resolution of w2.4 mm (compared to w10 mm in previous OCT studies). The microprobe and distal-scanning probe had an outer diameter of w1 mm and w1.8 mm (with protective plastic sheaths), respectively, which were small enough to pass through the accessory port of duodenoscope. A customized ball-lens and diffractive lens was implemented in the distal optics designs for the microprobe and distal-scanning probe, respectively, compensating the severe chromatic aberration incurred from the broad spectral bandwidth at 800nm. Fig. 1 (A) and (B) are photographs of the microprobe and distal-scanning probes, respectively. The microprobe consisted of a home-made fiber ball lens (as shown in inset of (A)) protected with a hypodermic tube. In conjunction with a home-made capillary tube-based rotary joint, the microprobe can rotate at a speed up to 35 revolutions/sec. The distal scanning endoscope consisted of a compound lens, custom diffractive element and miniature micromotor. It can rotate at a speed up to 100 revolutions/sec. The entire assembly was housed within a custom laser cut enclosure. Results: The representative ultrahigh resolution OCT images of swine bile duct shown in Fig.1. (C) and (D) were acquired with microprobe and distal-scanning probe, respectively. Biliary ductal structure such as submucosal glands, muscle layer and serosa were clearly observed and well correlated with histology displayed in Fig.1 (E) and (F). Conclusions: This study demonstrates ultrahigh resolution endoscopic OCT at 800 nm with super-achromatic microprobe and distal-scanning probe for imaging swine bile duct ex vivo. Further studies in ex vivo human bile duct is underway. Acknowledgment: We are grateful for the supports from the Wallace H. Coulter Foundation and the NIH (R01 HL121788).
Figure 1. (A) Photograph of microprobe which consists of a fiber balllens in the 25 gauge protective tube, inset: zoomed-in view of fiber balllens. (B) Distal-scanning probe. (C) and (D), representative ultrahigh resolution OCT images of swine bile duct acquired with microprobe and distal-scanning probe, respectively. (E) Corresponding H&E stained histology of bile duct. (F) Zoomed-in view of black boxed area of (E). M: muscularis, S: serosa, G: glands.
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB487