Time gated fluorescence spectroscopy in Barrett's oesophagus

Ortner, M.-A. E. J.; Ebert, B.; Hein, E.; Zumbusch, K.; Nolte, D.; Sukowski, U.; Weber--Eibel, J.; Fleige, B.; Dietel, M.; Stolte, M.; Oberhuber, G.; Porschen, R.; Klump, B.; Hörtnagl, H.; Lochs, H.; Rinneberg, H.
January 2003
Gut;Jan2003, Vol. 52 Issue 1, p28
Academic Journal
Background and aims: Specialised intestinal metaplasia and its dysplastic transformation, which precedes cancer in Barrett's oesophagus cannot be differentiated in standard gastroscopy. The aim of this study was to investigate whether laser induced protoporphyrin IX fluorescence permits the detection of specialised intestinal metaplasia and dysplasia during endoscopy and to take biopsy specimens in a guided rather than random manner. Methods: In 53 patients with Barrett's oesophagus 5-aminolaevulinic acid was sprayed on the mucosa. Approximately 60 to 120 minutes later, biopsy specimens were taken based on point-like measurements of delayed fluorescence intensity ratios of protoporphyrin IX in vivo. Two independent pathologists examined the 596 biopsy specimens taken, 168 of which were selected to be investigated by a third pathologist. Among these specimens only those (n=141) with a consensus diagnosis by at least two pathologists and p53 expression as additional marker were included in the analysis. Results: The median of normalised fluorescence intensity (ratio of delayed PplX fluorescence intensity to immediate autofluorescence intensity) in non-dysplastic specialised intestinal metaplasia (0.51, 68% CI 0.09 to 1.92) and Iow grade dysplasia (1.89, 68% CI 0.55 to 3.92) differed significantly (p<0.005). Dysplasia was detected at a rate 2.8-fold higher compared with screening endoscopy despite taking fewer specimens. In addition, three early cancers were detected for the first time. Moreover, this method permitted differentiation of specialised intestinal metaplasia from junctional or gastric-fundic type epithelium (p<0.013). Conclusions: For the first time it was possible to differentiate Iow grade dysplasia from non-dysplastic Barrett's mucosa during endoscopy based on delayed laser induced fluorescence endoscopy of PplX. Furthermore, the method helps to detect specialised intestinal metaplasia in short Barrett's oesophagus.


Related Articles

  • Short-segment Barrett's esophagus associated with high-grade dysplasia. Morita, Katsuo; Fujimori, Takahiro; Ono, Yuko; Masuyama, Hironori; Nakamura, Tetsuya; Terano, Akira // Journal of Gastroenterology;2002, Vol. 37 Issue 12, p1083 

    Describes a short-segment Barrett's esophagus complicated by high-grade dysplasia in a 51-year-old man. Findings of multiple areas of erosion in the lower esophagus using esophagogastroscopy; Histopathological findings in high-grade dysplasia of the biopsy specimens; Usefulness of genetic...

  • EXPRESSION ANALYSIS OF THE METAPLASIA DYSPLASIA CARCINOMA SEQUENCE IN BARRETT'S OESOPHAGUS AND ADENOCARCINOMA. Penman, I.D.; Smith, V.; Shen, E.F.; Wieand, D.; Landon, T.H.; Wong, N.A.C.S.; Lessells, A.M.; Paterson-Brown, S.; Tang, J.Z.; Wu, T.; Hillan, K.J. // Gut;Apr2003 Supplement 1, Vol. 52, pA7 

    Introduction and Aims: The molecular genetic events involved in the metaplasia dysplasia carcinoma (MDC) sequence in Barrett's oesophagus (CLO) are incompletely understood. We applied microarray expression analysis of endoscopic biopsies to study further these events and to detect novel genes...

  • Clinical: The basics - Gastro-oesophageal reflux disease.  // GP: General Practitioner;6/13/2012, p22 

    The article offers information about gastro-oesophageal reflux disease (GORD). Around 10-20% of the adult population has symptoms of GORD at some stage of their lives. GORD can lead to oesophagitis, but it is not very common; only around 8% of patients with GORD have moderate or severe...

  • Gastro-oesophageal reflux disease. Jankowski, Janusz; Jones, Roger; Delaney, Brendan; Dent, John // BMJ: British Medical Journal (International Edition);10/26/2002, Vol. 325 Issue 7370, p944 

    Illustrates how to consult with a patient that has gastro-oesophageal reflux disease. Issues to cover; Steps to take; Indications for a prompt gastroscopy.

  • Symptoms, acid exposure and motility in patients with Barrett's esophagus. Brandt, Michael G.; Darling, Gail E.; Miller, Linda // Canadian Journal of Surgery;Feb2004, Vol. 47 Issue 1, p47 

    Introduction: Barrett's esophagus, a syndrome in which the squamous mucosa that normally lines the distal esophagus is replaced with columnar epithelium, is found in a small percentage of patients presenting with gastroesophageal reflux disease (GERD). The columnar epithelium may be...

  • Magnification chromoendoscopy for the detection of intestinal metaplasia and dysplasia in Barrett's oesophagus. Sharma, P.; Weston, A.P.; Topalovski, M.; Cherian, R.; Bhattacharyya, A.; Sampliner, R.E. // Gut;Jan2003, Vol. 52 Issue 1, p24 

    Background: The presence of intestinal metaplasia (IM) in the columnar lined distal oesophagus defines Barrett's oesophagus with the risk of future malignant transformation. The distribution of both IM and dysplasia (Iow grade (LGD) and high grade (HGD)) within the columnar lined oesophagus is...

  • Endoscopy II.  // Gut;Jul2012 Supplement, Vol. 61, pA267 

    The article presents abstracts on medical topics of Great Britain which include the cost of baristric surgery for endoscopy, indications of colonoscopy and the detection of dysplasia in Barrett's oesophagus.

  • Long-term Follow-up of Barrett's High-Grade Dysplasia. Weston, Allan P.; Sharma, Prateek; Topalovski, Margaretia; Richards, Robert; Cherian, Rachel; Dixon, Anita // American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p1888 

    OBJECTIVE: The management of Barrett's high-grade dysplasia (HGD) remains controversial. The aims of this study were to evaluate prospectively the outcome of unifocal HGD (uHGD) in patients with Barrett's esophagus, and to determine demographic and endoscopic features predictive of progression...

  • The Last Page. Ruoff, Michael // American Journal of Gastroenterology;Jun1978, Vol. 69 Issue 6, p716 

    Presents several gastroenterology-related questions based on the articles featured in the June 1978 issue of "The American Journal of Gastroenterology." Indications for peritoneoscopy; Features suggestive of Crohn's disease of the esophagus; Evaluations of cardiovascular responses to upper...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics