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166 IN-VIVO PATHOLOGICAL ASSESSMENT OF BARRETT'S ESOPHAGUS WITH ENDO-CYTOSCOPY SYSTEM S Cho, M Cirocco, N Basset, G Kandel, P Kortan, G May, N Marcon BACKGROUND AND AIMS: The current endoscopic surveillance of Barrett's esophagus with random biopsies is limited by sampling errors, as most dysplastic lesions and non-invasive cancers are indistinguishable from background Barrett's esophagus on conventional endoscopy. Endo-cytoscopy system is a novel ultra-high magnification endoscopy system which enables cellular level microscopic observation of the mucosa. The aims of this study were to observe and describe endo-cytoscopic characteristics of normal, metaplastic and dysplastic esophageal mucosa in-vivo and to assess the ability of the endo-cytoscopy system in improving the diagnostic yield of dysplasia in endoscopic surveillance of Barrett's esophagus.
Division of Gastroenterology and Therapeutic Endoscopy, St Michael's Hospital, University of Toronto, Toronto, Ontario
METHODS: Patients with known Barrett's esophagus undergoing endoscopic surveillance were included in this prospective study and were evaluated with the endo-cytoscopy following a standard endoscopy examination. The endo-cytoscopy system (XEC 300, Olympus Corporation, Tokyo, Japan) used in the study consists of a flexible endoscope which is passed through the instrument channel of the standard therapeutic gastroscope (GIF-1T, Olympus). It provides 450x magnifications and a field of view of 300x300µm of tissue. During endo-cytoscopy examination, esophageal mucosa was stained with 1% methylene blue, and macroscopically suspicious lesions seen with standard endoscopy were examined followed by endoscopically unremarkable Barrett's mucosa in circumferential fashion at 1 to 2cm intervals. Mucosal biopsies were then taken from the respective areas to correlate with the endo-cytoscopic images followed by four-quadrant, 1 to 2cm interval biopsies as per current practice of care.
RESULTS: Twelve patients have undergone the endo-cytoscopy examinations so far. It was possible to obtain clear images from normal squamous, Barrett's and dysplastic esophageal mucosa, and assess the characteristics of nuclei, nucleus cytoplasm ratio and glandular architecture to correlate with the histological findings.
CONCLUSION: Endo-cytoscopy provides real-time histological images and has potential to improve the diagnostic yield of conventional endoscopic surveillance for early neoplasia in Barrett's esophagus. Further studies are warranted.