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Proceedings Paper

Duodenal imaging by tethered capsule OCT endomicroscopy in adolescents with environmental enteric dysfunction (Conference Presentation)
Author(s): Jing Dong; Kamran Sadiq; Catriona Grant; Omair Shakil; David Otuya; Hamid Farrokhi; Anna Gao; Nitasha Bhat; Sarah Giddings; Kumail Ahmed; Seema Rani; Mireille Rosenberg; Alessio Fasano; Christopher Damman; Asad Ali; Guillermo Tearney

Paper Abstract

Environmental Enteric Dysfunction (EED) is a poorly understood condition of the small intestine that is prevalent in regions of the world with inadequate sanitation and hygiene. EED affects 25% of all children globally and causes over a million deaths each year. The condition is associated with increased intestinal permeability, bacterial translocation, inflammation and villous blunting. The loss of absorptive area and intestinal function leads to nutrient malabsorption, with long term outcomes characterized by stunted growth and neurocognitive development. Currently, the only way to directly evaluate the morphology of the intestine is endoscopy with mucosal biopsy. Yet because EED is endemic in low and middle-income countries, endoscopy is untenable for studying EED. As a result, the diagnosis of EED and the assessment of the efficacy of EED interventions is hampered by an inability to evaluate the intestinal mucosa. Our lab has previously developed a technology termed tethered capsule OCT endomicroscopy (TCE). The method involves swallowing an optomechanically-engineered pill that generates 3D images of the GI tract as it traverses the lumen of the organ via peristalsis, assisted by gravity. In order to study the potential of using TCE to investigate EED, we initiated and conducted a TCE study in adolescents at Aga Khan Medical Center in Pakistan. To make swallowing easier, the tethered capsule’s size was reduced from 11x25 mm to 8x22 mm. Villous morphologic visualization was enhanced by building a notch (x mm deep, y mm wide) in the capsule’s imaging window. To date, 26 Pakistani subjects with ages ranging from 14 to 18 y/o (16.4 +/- 1.0) have been enrolled and imaged. A total of 19 subjects were able to swallow the capsule. Of those, 9 successfully passed through the pylorus, allowing successful microscopic imaging of the entire duodenum. There were no adverse events in any of the cases. Maximum villous height and width were measured from 3 randomly chosen, representative frames from each Pakistan subject as well as a matching number from US controls. Preliminary results, comparing Pakistani vs US villous morphology, indicated that subjects from Pakistan have shorter (628.6 +/- 22.0 um and 492.3 +/- 13.2 um, respectively, p< 0.0001) and wider duodenal villi (244.9 +/- 8.8 um and 293.4 +/- 13.2 um, respectively, p< 0.0001). These findings suggest that OCT TCE of the duodenum may be a useful tool for evaluating villous morphology in EED.

Paper Details

Date Published: 4 March 2019
Proc. SPIE 10854, Endoscopic Microscopy XIV, 1085408 (4 March 2019); doi: 10.1117/12.2513965
Show Author Affiliations
Jing Dong, Wellman Ctr. for Photomedicine (United States)
Kamran Sadiq, The Aga Khan Univ. (Pakistan)
Catriona Grant, Wellman Ctr. for Photomedicine (United States)
Omair Shakil, Wellman Ctr. for Photomedicine (United States)
David Otuya, Wellman Ctr. for Photomedicine (United States)
Hamid Farrokhi, Wellman Ctr. for Photomedicine (United States)
Anna Gao, Wellman Ctr. for Photomedicine (United States)
Nitasha Bhat, Wellman Ctr. for Photomedicine (United States)
Sarah Giddings, Wellman Ctr. for Photomedicine (United States)
Kumail Ahmed, The Aga Khan Univ. (Pakistan)
Seema Rani, The Aga Khan Univ. (Pakistan)
Mireille Rosenberg, Wellman Ctr. for Photomedicine (United States)
Alessio Fasano, Massachusetts General Hospital (United States)
Christopher Damman, Univ. of Washington (United States)
Asad Ali, The Aga Khan Univ. (Pakistan)
Guillermo Tearney, Wellman Ctr. for Photomedicine (United States)

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

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