A NOVEL TECHNIQUE FOR SCREENING BARRETT'S ESOSPHAGUS

胃食道癌是白人男性中增长最快的癌症，是巴雷特食道的后果。巴雷特食管是一种由胃食管反流病（胃灼热）引起的恶性前病变。巴雷特食管的筛查只能通过内窥镜来完成，但考虑到高危人群，这种方法既昂贵又不切实际。本提案的目的是设计一种“光学活检”系统，可以被广泛的医疗保健提供者应用于筛查巴雷特食管。该系统将由一个光学探头组成，该探头可以放置在食管中，对患者的不适最小，该探头连接到一个光学活检控制台，该控制台将提供实时结果。主要的设计问题将是构建一个小口径的探针，它可以舒适地放置在食管中，并且可以扩展以提供与食管壁的接触，以便进行光学活检。第二个设计考虑将是构建一种算法，该算法将分析“光学活检”的光谱信号，该信号将区分上胃肠道的正常和异常组织。三种建议的探针设计将在切除的猪食管和胃中进行初步评估，以评估探针的部署及其安全性。随后，将在猪模型中评估探针，以评估其性能特征。将选择最佳设计进行临床试验。临床试验将包括在已知的巴雷特食管患者中使用探针，而对照组则接受内窥镜检查其他适应症。探针将在内窥镜检查之前通过，并将结果与内窥镜检查结果进行比较。该算法将来源于在内镜下同时对接受巴雷特食管内镜检查的患者进行的光学和组织学活检。开发一种可由医护人员操作的巴雷特食管筛查设备，将使大规模低成本筛查成为可能，以识别有患食管癌风险的患者。

Gastroesophageal cancers are the most rapidly increasing cancer in Caucasian males and are a consequence of Barrett's esophagus. Barrett's esophagus is a pre-malignant condition that is produced by gastroesophageal reflux disease (heartburn). Screening for Barrett's esophagus can only be accomplished by endoscopy that is expensive and impractical given the population at risk. The purpose of this proposal is to design an "optical biopsy" system that can be applied by a wide range of health care providers to screen for Barrett's esophagus. This system will consist of an optical probe that can be placed into the esophagus with minimal discomfort to the patient that is connected to an optical biopsy console that will provide real time results. The primary design issues will be in constructing a small caliber probe that can be comfortably placed into the esophagus and yet expandable to provide contact with the esophageal wall for an optical biopsy. The second design consideration would be in constructing an algorithm that would analyze the spectroscopic signal from the "optical biopsy" which would distinguish normal and abnormal tissue in the upper gastrointestinal tract. Three proposed probe designs will be evaluated initially in the resected porcine esophagus and stomach to assess deployment of the probes and their safety. Subsequently, the probes will be assessed in the pig model to evaluate their performance characteristics. The best design will be selected for clinical testing. The clinical trials will involve the use of the probe in patients with known Barrett's esophagus and a control group undergoing endoscopy for other indications. The probe would be passed prior to endoscopy and the results compared to the endoscopic findings. The algorithms will be derived from optical and histological biopsies taken simultaneously at endoscopy from patients undergoing surveillance endoscopy for Barrett's esophagus. The development of a screening device for Barrett's esophagus that could be operated by paramedical personnel would enable large-scale low cost screening to identify patients at risk for esophageal cancer.