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）： 巴雷特食管，也称为食管特殊肠上皮化生 (SIM)，是食管腺癌的先兆，食管腺癌是一种致命的癌症，其发病率正在以惊人的速度上升。该提案的长期目标是降低与食管腺癌相关的死亡率。有证据支持对大部分成年人口进行筛查以识别 SIM 患者。对巴雷特氏病患者进行定期监测可以在更早、更容易治疗的阶段发现不典型增生和腺癌。唯一可接受的 SIM 筛查方法是通过内窥镜引导进行活检。尽管这种方法已经很成熟，但绝大多数 (96-98%) 的腺癌是在事先没有诊断过 SIM 的患者中发现的。导致内镜活检筛查不足的重要因素是成本和准确性。这项工作的首要目标是开发和测试一种准确、成本较低的巴雷特食管筛查方法。我们之前已经证明，光学相干断层扫描 (OCT) 可以准确区分接受内窥镜检查的患者的食管 SIM 和正常鳞状上皮。在拟议的研究中，我们将开发利用 OCT 全面筛查整个远端食管的方法，无需内窥镜检查或患者镇静。目前的监测方案包括上消化道内窥镜检查和多次随机活检。由于不典型增生和腺癌是局灶性疾病，随机活检容易出现采样错误和高假阴性诊断率。这项研究的第二个目标是开发和测试一种基于光学引导活检的更灵敏的巴雷特食管患者监测方法。初步研究表明OCT可以进一步区分SIM以识别不典型增生和腺癌。我们建议对整个巴雷特区域进行系统成像，并对疾病最严重的位置进行直接活检。拟议的工作将扩展目前 OCT 的诊断能力，开发一种独立的成像方法来系统地评估远端食管，并测试这些新方法对患者进行筛查和监测。该计划将为医生提供一种改进的诊断工具，该工具将影响临床实践，并用于未来的研究，以解决有关该疾病患者的自然史和治疗的未解决的争议。