Transnasal Probe for Diagnosing Eosinophilic Esophagitis

用于诊断嗜酸性食管炎的经鼻探头

• 批准号: 8300082
• 负责人: Guillermo J Tearney
• 金额: $ 70.9万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8300082
• 关键词: Abate; Adrenal Cortex Hormones; Adult; Animals; Area; Asthma; Barrett Esophagus; Biopsy; Biopsy Specimen; Cadaver; Caliber; Child; Childhood; Clinical; Clinical Research; Confocal Microscopy; Conscious Sedation; Data; Deglutition Disorders; Devices; Diagnosis; Diagnostic; Diet; Disease; Distal; Dose; Dysplasia; Endoscopic Biopsy; Endoscopy; Eosinophilia; Eosinophilic Esophagitis; Eosinophilic Infiltrate; Epithelial; Esophageal; Esophageal mucous membrane; Esophagogastric Junction; Esophagus; Evaluation; Excision biopsy; Family; Fibrosis; Food; Food Hypersensitivity; Fright; Future; Goals; Gold; Healthcare Systems; Hematoxylin and Eosin Staining Method; Histology; Histopathology; Image; Incidence; Infiltration; Inflammatory; Knowledge; Laboratories; Lamina Propria; Lead; Left; Malignant neoplasm of esophagus; Methods; Microscopic; Monitor; Nausea and Vomiting; Optics; Organ; Outpatients; Patient Monitoring; Patients; Perforation; Pharmaceutical Preparations; Pilot Projects; Population; Prevalence; Procedures; Process; Quality of life; Rare Diseases; Research; Research Project Grants; Resolution; Scanning; Screening procedure; Sedation procedure; Sensitivity and Specificity; Slide; Speed; Squamous Epithelium; Steroids; Surface; Symptoms; System; Technology; Testing; Time; Tissues; Training; Tube; United States; Validation; base; cost; cost effective; design; dietary restriction; effective therapy; eosinophil; eosinophilic inflammation; experience; flexibility; follow-up; human tissue; imaging modality; imaging probe; in vivo; miniaturize; new technology; novel; pressure; response; sensor; standard of care; tool; upper GI series; validation studies

DESCRIPTION (provided by applicant): Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus, thought to be caused by food allergy, and characterized by the presence of eosinophils within the esophageal mucosa. Even though it is a relatively new disease, EoE is now recognized to be common in both adult and pediatric populations and rapidly rising in incidence. Patients with EoE can experience a variety of upper GI symptoms, ranging from dysphagia to food impaction. Experts fear that if left untreated, EoE may lead to esophageal fibrosis and stricture formation. It is therefore currently recommended that this disease be treated until the symptoms and the eosinophilic infiltrate have resolved. EoE therapy options include corticosteroids and aggressive dietary restriction followed by gradual food reintroduction. While both treatments are effective, EoE returns following cessation of corticosteroids and numerous attempts at food reintroduction are needed to arrive at a diet that provides a good quality of life. As a result, management of EoE patients involves frequent follow up to monitor the patient's clinical and histopathologic response to changes in steroid dosing and/or diet. This strategy is arduous for patients and their families, and costly, as multiple endoscopy sessions must be conducted over time to procure esophageal biopsies and monitor eosinophil counts. We have developed a new technology called spectrally-encoded confocal microscopy (SECM), that is capable of being incorporated into a small-diameter probe and can rapidly obtain depth-resolved microscopic image data over large epithelial areas in vivo. Originally developed to evaluate dysplasia and cancer of the esophagus, we have recently discovered that this imaging modality can also see esophageal eosinophils with a high degree of contrast. Much of the inconvenience and nearly half of the cost of endoscopy is a consequence of patient sedation that is required to perform the endoscopic procedure. In this proposal we will advance the SECM technology so that it can be used to monitor esophageal eosinophils without requiring sedation, endoscopy, or excisional biopsy. We will accomplish this task by developing small, flexible transnasal SECM probe that can be routinely inserted into the esophagus in the outpatient setting. In conjunction with a new high-speed SECM system, this device will automatically image a large portion of the esophagus and count eosinophils. Once the device has been constructed, validation studies will be conducted to demonstrate that the accuracy of this device is comparable to that of endoscopic biopsy. The end product of this research will be an esophageal eosinophil monitoring tool that is less expensive and far better tolerated than the current standard of care. Beyond its immediate clinical impact, this technology can also be used in future investigational studies to expand our knowledge of EoE and other diseases such as asthma that are characterized by tissue eosinophilia.

描述（由申请人提供）：嗜酸性粒细胞性食管炎（EoE）是一种食管炎症性疾病，被认为是由食物过敏引起的，其特征是食管粘膜内存在嗜酸性粒细胞。尽管 EoE 是一种相对较新的疾病，但现在人们认为 EoE 在成人和儿童人群中都很常见，并且发病率迅速上升。 EoE 患者可能会出现各种上消化道症状，从吞咽困难到食物嵌塞。专家担心，如果不及时治疗，EoE 可能会导致食管纤维化和狭窄形成。因此，目前建议治疗这种疾病，直到症状和嗜酸性粒细胞浸润消失。 EoE 治疗方案包括皮质类固醇和积极的饮食限制，然后逐渐重新引入食物。虽然两种治疗方法均有效，但 EoE 在停用皮质类固醇后会复发，并且需要多次尝试重新引入食物才能达到提供良好生活质量的饮食。因此，EoE 患者的管理涉及频繁随访，以监测患者对类固醇剂量和/或饮食变化的临床和组织病理学反应。这种策略对于患者及其家人来说是艰巨的，而且成本高昂，因为必须随着时间的推移进行多次内窥镜检查以获取食管活检并监测嗜酸性粒细胞计数。我们开发了一种称为光谱编码共焦显微镜（SECM）的新技术，该技术能够合并到小直径探针中，并且可以快速获得体内大上皮区域的深度分辨显微图像数据。最初是为了评估食管发育不良和癌症而开发的，我们最近发现这种成像方式还可以以高对比度看到食管嗜酸性粒细胞。内窥镜检查的大部分不便和近一半的费用是由于进行内窥镜检查所需的患者镇静造成的。在本提案中，我们将改进 SECM 技术，使其可用于监测食管嗜酸性粒细胞，而无需镇静、内窥镜检查或切除活检。我们将通过开发小型、灵活的经鼻 SECM 探头来完成这项任务，该探头可以在门诊环境中常规插入食道。与新的高速 SECM 系统相结合，该设备将自动对食道的大部分进行成像并计算嗜酸性粒细胞。一旦该设备建成，将进行验证研究，以证明该设备的准确性与内窥镜活检的准确性相当。这项研究的最终产品将是一种食管嗜酸性粒细胞监测工具，它比当前的护理标准更便宜且耐受性更好。除了其直接的临床影响之外，该技术还可以用于未来的研究，以扩展我们对 EoE 和以组织嗜酸性粒细胞增多为特征的其他疾病（例如哮喘）的了解。