The Tearney Lab at the Massachusetts General Hospital (MGH) has conducted a study using Tethered Capsule Endomicroscopy (TCE), a technique that involves swallowing a tethered capsule device that circumferentially scans an optical coherence technology (OCT) beam inside the body as it traverses the gastrointestinal tract. Throughout the procedure, microscopic images of the esophagus are acquired in real time in an unsedated subject. OCT TCE was used to screen for Barrett’s Esophagus in a setting of 2 primary care practices at MGH.The OCT TCE show promising results identifying BE in a primary care population.
We introduce two multimodal extensions of our optical coherence tomography (OCT) based tethered capsule endomicroscopy (TCE) platform, tailored towards an enhanced clinical applicability for upper gastrointestinal tract imaging. The first extension presented – white light (RGB)-OCT-based TCE – provides both, true-color visualization of the tissue surface and depth-resolved sub-surface OCT imaging, co-registered in time and space. The second extension presented – fluorescence (FL)-OCT-based TCE – enables the addition of tissue specific molecular contrast. We present compact, modular, easily portable, plug-and-play system designs for both extensions, as well as imaging results in swine esophagus, in vivo.
Environmental enteric dysfunction (EED) is a pathological condition of the small intestine that is endemic to low- and middle-income countries (LMICs). EED is thought to interfere with nutrient absorption and enteropathogen exclusion, resulting in altered immune response, increased infection, and limited neurological and physical development. Biopsy of the small intestine is the current diagnostic gold standard for diagnosis yet is untenable due to lack of availability in these countries. Endoscopic biopsy is further problematic since EED-related stunting can only be reversed if diagnosed in the first two years of life when endoscopy must be conducted under anesthesia in advanced medical care settings. Thus, there is an unmet need for a minimally invasive technology for obtaining small intestinal biopsies in unsedated infants in LMICs. To address this need, we have developed an OCT image-guided trans-nasal cryobiopsy device. The device comprises a dual-lumen 1.2 mm outer diameter (OD) probe, terminated by a metal tip, through which Freon is injected. The device is introduced through the lumen of a novel liquid-metal transnasal imaging tube that passively transits to the small intestine. M-mode OCT image guidance is used to determine when the metal tip is in contact with the mucosa so that cryobiopsies may be efficiently acquired. We have conducted feasibility experiments using this device in 10 swine in vivo, demonstrating residual bleeding that is comparable to conventional excisional biopsy, tissue sampling volumes that are greater than or equal to those of conventional biopsy, and high-quality histopathology. These results suggest that this transnasal cryobiopsy technique may be suitable for infants in low-resource settings where EED is prevalent, due to its simplicity and its ability to be used in unsedated subjects.
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