Improving screening & surveillance in Barrett's patients

改善筛查

• 批准号: 6933048
• 负责人: Guillermo J Tearney
• 金额: $ 53.23万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-08-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6933048
• 关键词: Barretts esophagus; adenocarcinoma; bioimaging /biomedical imaging; biopsy; clinical research; diagnosis design /evaluation; diagnosis quality /standard; endoscopy; esophagogastric junction; gastrointestinal disorder diagnosis; human mortality; human subject; human therapy evaluation; image guided surgery /therapy; image processing; longitudinal human study; mass screening; method development; optical tomography; patient oriented research; questionnaires; sensory depression; stomach

DESCRIPTION (provided by applicant): Barrett's esophagus, also termed specialized intestinal metaplasia (SIM) of the esophagus, is the precursor to esophageal adenocarcinoma, a lethal cancer that is rising in incidence at an alarming rate. The long-term objective of this proposal is to decrease the mortality associated with esophageal adenocarcinoma. Evidence supports screening a large percentage of the adult population to identify patients with SIM. Regular surveillance of patients with Barrett's can then identify dysplasia and adenocarcinoma at an earlier, more treatable stage. The only accepted method for screening for SIM is biopsy through endoscopic guidance. Although this approach is well established, the vast majority (96-98%) of adenocarcinomas are found in patients without prior diagnosis of SIM. Important factors that contribute to the inadequacy of endoscopic biopsy for screening are cost and accuracy. The first goal of this work is to develop and test an accurate, less expensive screening method for Barrett's esophagus. We have previously demonstrated that optical coherence tomography (OCT) can accurately distinguish esophageal SIM from normal squamous epithelium in patients undergoing endoscopy. In the proposed research we will develop methods for comprehensively screening the entire distal esophagus with OCT without requiring endoscopy or patient sedation. Current surveillance protocols consist of upper endoscopy with multiple random biopsies. Since dysplasia and adenocarcinoma are focal diseases, random biopsy is subject to sampling errors and high rates of false negative diagnoses. The second goal of this research is to develop and test a more sensitive method for surveillance in patients with Barrett's esophagus based on optically guided biopsy. Preliminary studies suggest that OCT can further differentiate SIM to identify dysplasia and adenocarcinoma. We propose to systematically image the entire Barrett's region and direct biopsy to locations that contain the most severe disease. The proposed work will expand the current diagnostic capabilities of OCT, develop a standalone imaging method for systematically evaluating the distal esophagus, and test these new methods for screening and surveillance in patients. This program will provide physicians with an improved diagnostic tool that will impact clinical practice as well as be used for future studies to address unresolved controversies regarding the natural history and treatment of patients with this disease.

描述（由申请人提供）： 巴雷特的食管也被称为食管的专门肠道化生（SIM），是食管腺癌的前体，这是一种致命的癌症，这是一种以惊人的速度发病率上升的致命癌。该提议的长期目标是降低与食管腺癌相关的死亡率。证据支持筛查很大一部分的成年人口，以识别SIM患者。随后对Barrett的患者进行定期监测，可以在更早的，更可治疗的阶段鉴定出发育不良和腺癌。筛选SIM的唯一接受方法是通过内窥镜指导进行活检。尽管这种方法已经确定，但在没有先前诊断为SIM的患者中发现了绝大多数（96-98％）的腺癌（96-98％）。筛查内窥镜活检不足的重要因素是成本和准确性。这项工作的第一个目标是为巴雷特食管开发和测试一种准确，更便宜的筛查方法。我们先前已经证明，光学相干断层扫描（OCT）可以在接受内窥镜检查的患者中准确地将食管SIM与正常鳞状上皮区分开。在拟议的研究中，我们将开发用于全面筛查整个远端食道的方法，而无需内窥镜检查或患者镇静。当前的监视方案由内窥镜上镜检查和多个随机活检组成。由于发育不良和腺癌是局灶性疾病，因此随机活检受到采样错误和假阴性诊断率高的率。这项研究的第二个目标是基于光学引导活检的患者开发和测试一种更敏感的监测方法。初步研究表明，OCT可以进一步区分SIM以鉴定发育不良和腺癌。我们建议系统地对整个Barrett区域进行成像，并将活检直接到包含最严重疾病的位置。拟议的工作将扩大OCT的当前诊断能力，开发一种独立的成像方法，用于系统地评估食管远端，并测试这些新方法以筛查和监测患者。该计划将为医生提供改进的诊断工具，该工具将影响临床实践，并用于未来的研究，以解决有关这种疾病患者的自然病史和治疗的未解决的争议。