Spectroscopic diagnosis of esophageal dysplasia

Max Almond, MB, ChB, DM, from Gloucestershire Royal Hospital in Gloucester, United Kingdom, discusses his original article “Endoscopic Raman spectroscopy enables objective diagnosis of dysplasia in Barrett’s esophagus” from the January issue.

This study evaluated a novel endoscopic diagnostic probe for use in patients with Barrett’s esophagus. Up to 57% of Barrett’s-associated dysplasia may be missed using random quadrantic biopsies in conjunction with high-definition white light endoscopy. Existing advanced endoscopic imaging tools including confocal microscopy and chromoendoscopy are subjective and not user-friendly.

Figure 1Figure 1. Unprocessed 1-second Raman probe spectra measured from Barrett’s esophagus, adenocarcinoma, and normal squamous esophagus. Spectra have been offset for clarity. An air background spectrum is shown for comparison, and prominent spectral features have been identified.

There are emerging data to support the early treatment of low-grade dysplasia (European SURF RCT). These lesions in particular are difficult to identify endoscopically. An accurate endoscopic diagnostic tool could enable early diagnosis and targeted treatment of dysplastic lesions (endoscopic resection followed by whole segment radio frequency ablation [RFA]).

A new diagnostic technique termed endoscopic Raman spectroscopy (ERS) has been described. ERS is safe, quick and easy to use, entirely objective, and highly accurate. It is capable of distinguishing between high-grade dysplasia, low-grade dysplasia, and non-dysplastic Barrett’s esophagus based on consistent biochemical differences between these tissue types. ERS could be used to facilitate targeted endoscopic resection, ensure R0 resection rates, and limit the incidence of missed or incompletely treated disease.

Find this article on pages 37-45 of the print journal or read the abstract online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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