Fluorescence Endoscopy

Oesophageal cancer often presents at a late incurable stage. Oesophageal adenocarcinoma can in some cases arise from Barrett’s oesophagus – a premalignant condition where there is an abnormal change in the cells of the lower oesophagus. Low survival rates in this disease underpin initiatives to identify those with early stage disease and to develop biomarkers to predict risk of progression. The oesophagus is easily accessible via endoscopy and hence ideally suited to molecular diagnostic approaches, which can be coupled with minimally invasive endoscopic therapies for early disease.

So far, research has focussed on the application of molecular analysis to endoscopic biopsies. However, this does not circumvent the significant problem of sampling bias since the dysplastic Barrett's mucosa can be flat and indistinguishable endoscopically from healthy oesophageal tissue. Endoscopic imaging tools, such as auto-fluorescence and narrow band imaging, have high false positive rates and a narrow field of view. We have developed a novel method by which fluorescently-tagged and topically applied naturally occurring lectins are used to detect changes in glycosylation of the surface epithelium of the oesophagus in the progression to Barrett's adenocarcinoma using fluorescence endoscopy. This approach has the potential to be extended to other pre-cancerous lesions of the aerodigestive tract.

In order to achieve translation of these fluorescence endoscopy technologies into the clinic, we have two key aims. Firstly, as preparation for a clinical trial, we must determine the optimal lectin(s), undertake toxicity studies and obtain pilot clinical data. Secondly, we intend to carry out a prospective multicentre in vivo molecular imaging trial using lectins in the Barrett’s oesophagus surveillance population. This study will determine the sensitivity and specificity of lectins as molecular imaging tools.

Professor Rebecca Fitzgerald

Senior Research Group Leader at the MRC Cancer Unit at the University of Cambridge and Consultant at Cambridge University Hospitals NHS Foundation Trust.

Dr Yeng Ang

Consultant at Wrightington, Wigan and Leigh NHS Foundation Trust.

Professor Kevin Brindle

Chair in Biomedical Magnetic Resonance at the University of Cambridge.