New Methods & Materials
High-resolution imaging of the human esophagus and stomach in vivo using optical coherence tomography,☆☆

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Abstract

Background: Optical coherence tomography is a new, high spatial–resolution, cross-sectional imaging technique. We investigated the ability of optical coherence tomography to provide detailed images of subsurface structures in the upper gastrointestinal (GI) tract. Methods: Optical coherence tomography was performed during routine upper GI endoscopy on 32 patients including 20 patients with Barrett's esophagus. An endoscopic mucosal biopsy was obtained immediately after imaging and was used for histopathologic correlation. Results: Optical coherence tomography provided clear delineation of layers of the normal human esophagus extending from the epithelium to the longitudinal muscularis propria. Gastric mucosa was differentiated from esophageal mucosa, Barrett's esophagus was differentiated from normal esophageal mucosa, and esophageal adenocarcinoma was distinguished from normal esophagus and Barrett's esophagus. Conclusions: Optical coherence tomography allows visualization of the subsurface architectural morphology of the upper GI tract. The diagnostic information provided by this new imaging modality suggests that it may be a useful adjunct to endoscopy.

Section snippets

METHODS

As in US imaging, OCT uses an interrogating beam that is focused to a narrow diameter within the sample. The fraction of light that is reflected backward to the emitter is detected. In US, the temporal delay between the emission of the interrogating beam and the detection of the reflection is measured to determine the distance from the emitter to the reflection site. In OCT, the temporal delay is too brief to be measured electronically. Instead, OCT measures the path length traveled by the

Normal esophageal mucosa

It was possible to clearly delineate five anatomic layers in the OCT images of normal esophagus acquired in vivo (Fig. 2).

. Normal esophagus. A, Endoscopic view showing the OCT catheter placed adjacent to the esophageal wall. B through D, OCT images of normal esophagus taken from three different patients. The layers visible in the OCT images correspond to epithelium (ep ), lamina propria (lp ), muscularis mucosa (mm ), submucosa (sm ), and the inner, circular layer of the muscularis propria (mp

DISCUSSION

This study represents the first clinical application of OCT in the United States for imaging of the GI tract and provides the highest resolution images ever obtained endoscopically. Comparisons of histology and OCT images indicate that OCT provides morphologic and diagnostic information. Both the high resolution of OCT and the inherent contrast provided by the differences in the reflectance of cellular and extracellular constituents in tissue contribute to the quality of the images produced.

Acknowledgements

We thank William Puricelli, RN, for technical assistance.

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Supported in part by the Whitaker Foundation, the Medical Free Electron Laser Program, Office of Naval Research, and by a grant from the Partners' Center for Innovative Minimally Invasive Therapy.

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Reprint requests: Brett E. Bouma, PhD, MGH-BAR 703, 50 Blossom St., Boston, MA 02114.

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