Evaluation of Barrett esophagus by multiphoton microscopy

Area of Science:

• Biomedical Optics
• Gastroenterology
• Pathology

Background:

• Multiphoton microscopy (MPM) enables visualization of fresh, unstained tissues, including cellular and extracellular matrix components.
• Development of portable MPM and endomicroscopes is underway, but clinical utility remains unestablished.

Purpose of the Study:

• To characterize normal esophageal squamous and gastric columnar mucosa using MPM.
• To assess the reliability of MPM for diagnosing intestinal metaplasia/Barrett esophagus (BE) in endoscopic biopsies.

Main Methods:

• Examined 35 fresh endoscopic biopsy specimens using a Ti:sapphire laser-based MPM system.
• Compared MPM images with subsequent histopathology of formalin-fixed, paraffin-embedded tissues.
• Analyzed MPM characteristics of squamous, gastric-type columnar, and intestinal-type columnar epithelium.

Main Results:

• MPM successfully distinguished squamous cells, goblet cells, gastric mucous cells, and parietal cells based on autofluorescence.
• Intestinal metaplasia (goblet cells) was detected in 40% of cases by MPM versus 28% by histopathology.
• MPM visualized connective tissue components like elastin and collagen in the lamina propria.

Conclusions:

• MPM accurately differentiates esophageal and gastric mucosal types and identifies goblet cells, essential for BE diagnosis.
• In-suite MPM could provide immediate microscopic feedback during endoscopy, enhancing BE screening and surveillance.