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Confocal microscope is a giant step in esophageal cancer

November 15, 2010

Diagnosis and treatment of esophageal cancer—the fastest growing cancer in the Western world—is taking a giant step forward with a procedure that uses the world’s smallest microscope to pinpoint tiny cancerous and potentially precancerous cells.

Yale Medical Group is the only practice in Connecticut to use confocal endomicroscopy to make a precise aid in the diagnosis of Barrett’s esophagus with dysplasia or localized cancer. Barrett’s is a condition that causes changes in the cells lining the lower esophagus and can be a precursor to cancer. The procedure can also identify dysplastic tissue that might be missed in a routine endoscopy.

Uzma Siddiqui, MD, director of Endoscopic Ultrasound for Yale Medical Group, demonstrated the procedure in a video for Channel 8 News.

She uses a microscope attached to the tip of a long, thin, flexible probe that is inserted through the accessory channel of a standard endoscope. “You shine this lower powered blue laser onto the point of interest and then the light is emitted from the tissue, and it’s collected and detected in the confocal system,” said Dr. Siddiqui in the interview with Channel 8.

Images obtained by the confocal system are magnified 1,000 times.“It allows you to focus in on an area and have extreme magnification that you wouldn't otherwise obtain," she said. Siddiqui performs another nonsurgical endoscopic technique called radiofrequency ablation that uses heat energy to remove high-risk Barrett’s tissue without damaging underlying structures and can also remove small, superficial early cancers with endoscopic mucosal resection.

Catching malignancies early

The National Cancer Institute estimates there will be 16,640 new cases of esophageal cancer in the United States in 2010, and 14,500 deaths. Patients diagnosed with Barrett’s must undergo regular endoscopies and biopsies so that malignant changes can be caught early.

Gary Rolf, a patient who underwent the procedure, was able to avoid major surgery because his early esophageal cancer was detected using confocal endomicroscopy and successfully removed endoscopically. “I had that acid reflux, it was just constant that acid, that burning in my espahogus,” said Rolf, who appeared in the Channel 8 interview and is now cancer free. “I was all for it. It's new, it's high tech.”

A tool for other cancers

Meanwhile, Priya Jamidar, MD, director of Endoscopy at Yale Medical Group, is using confocal microscopy in the bile duct, where tissue sampling techniques are at best, 50 percent sensitive. Yale has the most experience of any center with the use of the high-resolution probe in the bile duct, and Jamidar believes the new technology may improve diagnosis and help guide therapy.

In 2009, Harry Aslanian, MD, associate director of Endoscopy, performed the world’s first confocal laser endoscopic visualization of the interior of a pancreatic mass, and has done several similar procedures since then on pancreatic cysts. While the Food and Drug Administration has already approved its use for gastrointestinal endoscopy, the procedure for the pancreas is still in the clinical trial phase. Aslanian mentioned in the Channel 8 interview, “Before, doctors had to perform a biopsy, remove the tissue and wait a day before looking at the results on a microscope. Benefits of using confocal microscopy include the ability to act on information in real time, along with more accurate diagnoses and immediate treatment.”

To contact the Yale Interventional Endoscopy Program, please call 203-785-4138.

Submitted by Mark Santore on January 16, 2014