Colonic Neoplasms Clinical Trial
Official title:
Optical Polyp Testing for In Vivo Classification
Small growths detected in the colon (polyps) during a colonoscopy may or may not have the potential to develop into cancer. However, since visual inspection alone cannot separate all potentially harmful polyps from harmless ones, the standard approach is to remove them all for histological lab examination, exposing patients to risk of injury and putting a significant demand on hospital resources. An accurate method of determining polyp type during endoscopy would enable the clinician to only remove potentially harmful polyps. A new endoscopic optical imaging probe (OPTIC), which analyses how light interacts with tissue, is proposed to do this. The probe is contained within a normal endoscope and uses white light and blue/violet laser light to illuminate the tissue. The reflected and fluorescent light emitted, along with normal colour pictures of the polyp surface, are measured and recorded to quantify specific characteristics of each type. Optical measurements of polyps detected in endoscopy clinics at Imperial College Healthcare NHS Trust will be analysed to determine if the signal can be used to differentiate different polyp types.
Polyps detected during a colonoscopy may range from benign to precancerous and cancerous.
While experienced endoscopists can reliably recognise cancer, the difference between small
polyps that have the potential to develop into cancer (adenomas) and those that do not
(hyperplastic), is often ambiguous. The standard approach is to simply remove all polyps and
analyse them in the histology lab. This means that many patients with hyperplastic polyps
(40% of those detected) are unnecessarily exposed to risk of injury (bowel perforation and
bleeding) during removal. Furthermore the NHS faces the significant cost of diagnosing this
harmless colon tissue. If clinicians were able to accurately determine polyp type during
endoscopy, without removal, then hyperplastic tissue could be left alone while potentially
harmful tissue is removed.
A pilot study of a new endoscopic optical imaging probe (OPTIC), which analyses how different
colours of light interact with tissue, is proposed. Previous research has indicated that
these properties differ in hyperplastic and adenomatous polyps. The probe is contained within
a normal endoscope and uses white light and blue/violet laser light to illuminate the tissue.
The reflected and fluorescent light emitted, along with normal colour pictures of the polyp
surface, are measured and recorded to quantify specific characteristics of each type.
Patients attending endoscopy clinics at Imperial College Healthcare NHS Trust will be asked
to allow the use of the OPTIC probe during their colonoscopy. If the clinician detects a
polyp that he/she intends to remove then this will be analysed using OPTIC before removal.
The histology results from the tissue sample will be recorded and correlated to the OPTIC
probe measurements. The resulting library of optical data will be used to design software to
automatically categorise unknown polyps based on the OPTIC signal. The accuracy of the
technique will be compared to the clinicians' visual assessments. The patients' involvement
in the study ceases after the colonoscopy.
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