Tethered capsule endomicroscopy (TCE) is a recently developed form of in vivo microscopy based on optical coherence tomography (OCT). With TCE, a small tethered pill is swallowed, procuring high resolution microscopic images of the esophageal wall. TCE does not require sedation and is thus a more rapid and convenient procedure comparing to traditional endoscopic examination. Our group and others have successfully conducted OCT-TCE in pilot, single-center studies that demonstrated the potential of this technology for upper GI tract diagnosis. Here, we demonstrate and evaluate the feasibility and safety of a next generation OCT-TCE system and device in patients with Barrett’s esophagus (BE) and report the initial longitudinal analysis of the natural history of BE.
Celiac disease (CD) affects around 1% of the global population and can cause serious long-term symptoms including malnutrition, fatigue, and diarrhea, amongst others. Despite this, it is often left undiagnosed. Currently, a tissue diagnosis of CD is made by random endoscopic biopsy of the duodenum to confirm the existence of microscopic morphologic alterations in the intestinal mucosa. However, duodenal endoscopic biopsy is problematic because the morphological changes can be focal and endoscopic biopsy is plagued by sampling error. Additionally, tissue artifacts can also an issue because cuts in the transverse plane can make duodenal villi appear artifactually shortened and can bias the assessment of intraepithelial inflammation. Moreover, endoscopic biopsy is costly and poorly tolerated as the patient needs to be sedated to perform the procedure.
Our lab has previously developed technology termed tethered capsule OCT endomicroscopy (TCE) to overcome these diagnostic limitations of endoscopy. TCE involves swallowing an optomechanically-engineered pill that generates 3D images of the GI tract as it traverses the lumen of the organ via peristalsis, assisted by gravity. In several patients we have demonstrated TCE imaging of duodenal villi, however the current TCE device design is not optimal for CD diagnosis as the villi compress when in contact with the smooth capsule’s wall. In this work, we present methods for structuring the outer surface of the capsule to improve the visualization of the villi height and crypt depth. Preliminary results in humans suggest that new TCE capsule enables better visualization of villous architecture, making it possibly to comprehensively scan the entire duodenum to obtain a more accurate tissue diagnosis of CD.
Due to the relatively high cost and inconvenience of upper endoscopic biopsy and the rising incidence of esophageal adenocarcinoma, there is currently a need for an improved method for screening for Barrett’s esophagus. Ideally, such a test would be applied in the primary care setting and patients referred to endoscopy if the result is suspicious for Barrett’s. Tethered capsule endomicroscopy (TCE) is a recently developed technology that rapidly acquires microscopic images of the entire esophagus in unsedated subjects. Here, we present our first experience with clinical translation and feasibility of TCE in a primary care practice. The acceptance of the TCE device by the primary care clinical staff and patients shows the potential of this device to be useful as a screening tool for a broader population.
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