Combination of confocal laser endo-microscopy and a molecular biomarker panel for the early diagnosis of neoplasia in Barrett’s

Principal Investigator: Dr Massimiliano di Pietro, MRC Cancer Unit

Co-Investigator: Professor Lorenz Wernisch, MRC Biostatistics Unit

Funded by: CRUK Cambridge Centre Early Detection Programme Pump Priming Awards 2016

Oesophageal cancer has poor prognosis and limited response to standard oncological and surgical therapies. The commonest cancer type in the Western world is the adenocarcinoma, which is normally preceded by a precancerous condition known as Barrett’s oesophagus (BO).

For this reason patients with BO are followed up with regular endoscopies and multiple random biopsies to allow diagnosis of dysplasia, which can be treated endoscopically to prevent cancer progression.However, dysplasia and often early cancer can be invisible at standard endoscopy and missed even by multiple biopsies. In addition, there is a lack of reliable tests to predict which patients with BO are at higher risk of cancer.

Advanced endoscopic technologies and tissue molecular tests offer a potential solution to this problem. Our previous research suggests that auto-fluorescence imaging (AFI), in combination with molecular tissue biomarkers and in vivo microscopic detection of dysplasia by confocal endo-microscopy allows accurate diagnosis, with the potential to improve patient risk stratification.

With a randomized study, we are seeking confirmation of this novel diagnostic algorithm. This has the potential to revolutionize the diagnostic approach to BO by in-vivo endoscopic diagnosis and molecular stratification in a single clinical intervention, to allow early treatment before cancer progression.