Comprehensive imaging of gastroesophageal biopsy samples by spectrally encoded confocal microscopy

Background: Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technique that has the potential to be used for acquiring comprehensive images of the entire distal esophagus endoscopically with subcellular resolution. Objective: The goal of this study was to demonstrate large-area SECM in upper G1 tissues and to determine whether the images contain microstructural information that is useful for pathologic diagnosis. Design: A feasibility study. Setting: Gastrointestibal unit, massachusetts general hospital Patients: Fifty biopsy samples from 36 patients undergoing routine egd were imaged by secm, in theirentirety, immediately after their removal Results: The microstructure seen in rhw secm images was similar to that seen by histopathology. gastric cardiamucosa was clearly differentiated from squamous mucosa. Gastric fundic/body type mucosa showed more tightly packed glands than gastric cardia mucosa. Fundic gland polyps showed cystrically dilated glands lined with cubo8idal epithelium. The presence of intraepithelial eosinophils was detected with the cells demonstrating a characteristic bilobed nucleus. Specialized intestinal metaplasia was identified by columnar epithelium and the presence of goblet cells. Barrett's esophagus (BE) with dysplasia was differentiated from specialized intestinal metaplasis by the loss of nuclear polarity and disorganized glandular architecture. Limitations: Ex vivo, descriptive study Conclusion: Large-area secm images of gastroesophageal biopsy samples enabled the visualization of both subcellular and architectural features of various upper gi mucosal types and were similar to the corresponding histopathologic slides. These results suggest that the development of an endoscopic secm probe is merited. (Gastrointest Endosc 2010;71:35-43.)