A NOVEL TECHNIQUE FOR SCREENING BARRETT'S ESOSPHAGUS

胃食管癌是高加索男性中增长最快的癌症，是巴雷特食管的结果。巴雷特食管是一种由胃食管反流病（胃灼热）引起的癌前病变。Barrett食管的筛查只能通过内窥镜检查来完成，考虑到高危人群，内窥镜检查既昂贵又不切实际。本提案的目的是设计一种“光学活检”系统，可由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，对患者的不适感最小，该探头连接到一个光学活检控制台，该控制台将提供真实的时间结果。主要设计问题将是构建一种小口径探头，该探头可以舒适地放置在食管中，但可扩展以提供与食管壁的接触，用于光学活检。第二个设计考虑是构建一种算法，该算法将分析来自“光学活检”的光谱信号，这将区分上胃肠道中的正常和异常组织。最初将在切除的猪食管和胃中评价三种拟定穿刺针设计，以评估穿刺针的展开及其安全性。随后，将在猪模型中评估穿刺针，以评价其性能特征。将选择最佳设计进行临床试验。临床试验将涉及在已知Barrett食管患者和接受其他适应症内窥镜检查的对照组中使用探头。在内窥镜检查前通过探头，并将结果与内窥镜检查结果进行比较。该算法将来自接受Barrett食管监测内镜检查的患者在内镜检查时同时采集的光学和组织学活检。开发一种可由辅助医务人员操作的Barrett食管筛查装置，将能够进行大规模低成本筛查，以识别有食管癌风险的患者。

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.