Original articleClinical endoscopyEsophageal-guided biopsy with volumetric laser endomicroscopy and laser cautery marking: a pilot clinical study
Section snippets
OCT VLE imaging system and balloon catheter
A schematic of the VLE imaging system and balloon-centering catheter is shown in Figure 1. The imaging system obtains microscopic images using optical frequency domain imaging (OFDI), a second-generation, high-speed form of OCT technology.7 OFDI images were acquired at a rate of 40,000 axial scans (A-lines, depth-resolved reflectivity profiles) per second.6 Each cross-sectional esophageal image contained 4096 A-lines; the resultant cross-sectional frame rate was 10 per second. The power, center
Results
The cautery-marking laser power emanating from the balloon-centering catheter was approximately 280 mW for the first 10 patients. One patient was excluded because of an esophageal stricture. During these procedures, a total of 14 sets of laser cautery marks were placed, with uneven success. Of these first 10 cases, only 6 sets of laser cautery marks (43%) were clearly visualized by endoscopy. For subsequent patients, the cautery-marking laser power transmitted through the balloon-centering
Discussion
In this article, we have demonstrated a new paradigm for guided biopsy of the esophagus in which, during acquisition of a 3-dimensional microscopic esophageal dataset, the operator clicks on a target region of interest on the image and creates laser cautery marks that delineate the target in the patient. Our findings in humans show that VLE-guided biopsy, implemented using 410 mW cautery laser irradiation, is a safe technique that reliably provides endoscopically visible marks on the esophagus
Acknowledgments
The authors gratefully acknowledge the support of W. Puricelli, A. Soomro, and J. Namati. We additionally would like to thank M. Shishkov for his technical assistance with device and component fabrication. We also acknowledge NinePoint Medical for use of their VLE viewer for visualization of images at a 1:1 aspect ratio.
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DISCLOSURE: Study data were collected and managed with REDCap electronic data capture tools hosted at Massachusetts General Hospital. Funding was provided by grants from the National Institutes of Health R01DK091923 (G.K.T.), R01CA103769 (G.J.T.), R21CA141884 (G.J.T.), and R00CA134920 (M.J.S.). Massachusetts General Hospital has a licensing arrangement with NinePoint Medical. M. Suter, B. Bouma, N. Nishioka, and G. Tearney have the rights to receive royalties from this licensing arrangement. G. Tearney, N. Nishioka, and B. Bouma consult for NinePoint Medical, and M. Suter, B. Bouma, and G. Tearney receive sponsored research funding from NinePoint Medical. All other authors disclosed no financial relationships relevant to this publication.