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Minimally invasive trans-nasal biopsy of the small intestine (Conference Presentation)
Author(s): David O. Otuya; Hamid Farrokhi; Jing Dong; Rachel Shore; Mason W. Schellenberg; Sarah L. Giddings; Nitasha G. Mudalaje; Catriona N. Grant; Aaron R. Baillargeon; Joseph A. Gardecki; Norman Nishioka; Christopher J. Damman; Guillermo J. Tearney
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Paper Abstract

Environmental enteric dysfunction (EED) is a pathological condition of the small intestine that is endemic to low- and middle-income countries (LMICs). EED is thought to interfere with nutrient absorption and enteropathogen exclusion, resulting in altered immune response, increased infection, and limited neurological and physical development. Biopsy of the small intestine is the current diagnostic gold standard for diagnosis yet is untenable due to lack of availability in these countries. Endoscopic biopsy is further problematic since EED-related stunting can only be reversed if diagnosed in the first two years of life when endoscopy must be conducted under anesthesia in advanced medical care settings. Thus, there is an unmet need for a minimally invasive technology for obtaining small intestinal biopsies in unsedated infants in LMICs. To address this need, we have developed an OCT image-guided trans-nasal cryobiopsy device. The device comprises a dual-lumen 1.2 mm outer diameter (OD) probe, terminated by a metal tip, through which Freon is injected. The device is introduced through the lumen of a novel liquid-metal transnasal imaging tube that passively transits to the small intestine. M-mode OCT image guidance is used to determine when the metal tip is in contact with the mucosa so that cryobiopsies may be efficiently acquired. We have conducted feasibility experiments using this device in 10 swine in vivo, demonstrating residual bleeding that is comparable to conventional excisional biopsy, tissue sampling volumes that are greater than or equal to those of conventional biopsy, and high-quality histopathology. These results suggest that this transnasal cryobiopsy technique may be suitable for infants in low-resource settings where EED is prevalent, due to its simplicity and its ability to be used in unsedated subjects.

Paper Details

Date Published: 4 March 2019
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Proc. SPIE 10854, Endoscopic Microscopy XIV, 108540M (4 March 2019); doi: 10.1117/12.2510447
Show Author Affiliations
David O. Otuya, Massachusetts General Hospital (United States)
Hamid Farrokhi, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Jing Dong, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Rachel Shore, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Mason W. Schellenberg, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Sarah L. Giddings, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Nitasha G. Mudalaje, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Catriona N. Grant, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Aaron R. Baillargeon, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Joseph A. Gardecki, Massachusetts General Hospital (United States)
Harvard Medical School (United States)
Norman Nishioka, Massachusetts General Hospital (United States)
Christopher J. Damman, Bill & Melinda Gates Foundation (United States)
Guillermo J. Tearney, Massachusetts General Hospital (United States)
Harvard Medical School (United States)


Published in SPIE Proceedings Vol. 10854:
Endoscopic Microscopy XIV
Guillermo J. Tearney; Thomas D. Wang; Melissa J. Suter, Editor(s)

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