AOTH - BSS Life Sciences

Richard (Rick) Mills
Ahead of the Herd

Page 1 of 2

As a general rule, the most successful man in life is the man who has the best information

An endoscope is the medical device used – by direct insertion – to visualize suspicious masses in the hollow organs of the body such as the gastrointestinal tract, esophagus, lungs, urinary tract and uterus.

In 1805, Philip Bozzini used a rudimentary, light-guiding tube he created (a Lichtleiter – light guiding instrument) to view the urinary tract, pharynx, and rectum.

In 1853, Antoine Jean Desormeaux developed an instrument to view urinary structures. Desormeaux called his instrument an “endoscope.”

In the 1960’s fiber optics allowed a major reduction in the size of the endoscope and helped clarify the doctor’s view. Use of endoscopes in the practice of medicine exploded.

The endoscopy procedure is used to confirm a diagnosis when other tools, such as an MRI, X-ray, or CT scan are considered inappropriate or unclear. 

Endoscopies are commonly performed in the diagnosis of cancer; for taking samples of tissue, called biopsies, to find out whether it is cancerous as well as for complete excision (the cutting out) of suspicious lesions.

There are many different types of endoscopes and depending on the site in the body, and the type of procedure, endoscopy may be performed by a doctor or a surgeon, and the patient may be fully conscious or under general anesthetic.

Endoscopes are also used in laparoscopic surgery in which a small incision is made, usually in the navel, through which a viewing tube is inserted. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube.

Laparoscopes are also utilized in surgery to visualize various organs and tissues within the body during surgical removal and to avoid damage to adjacent organ and vascular systems and other critical structures. Laparoscopy is less invasive than regular open abdominal surgery.

Because of the endoscope biopsies of the intestines or lungs can be done without the need for major surgery.

White Light

Visible light, or what we call “white light” has been utilized in endoscopes for decades to guide the physician and surgeon so they can “see” the cancer in the organ of interest and subsequently for biopsy and in the removal of suspicious masses.

However, white light has visualization limitations for all cancer types because white light cannot pass through tissue or blood and cannot illuminate tumors beneath the skin surface.

In addition, white light is noteffective in visualizing the borders of the tumor to determine where it starts and ends (the margins) especially after the initial removal of the main mass. 

If the surgeon does not remove allthe cancerous growth and a few cancerous cells remain, or does not remove all cancerous cells at the margins, the tumor can grow back and spread or metastasize to other parts of the body.

Another major problem with endoscopes that utilize only white light is that malignant and premalignant tumors that are flat, or very small, may look similar to normal tissues. As a result a physician may not be able to identify some aggressive cancers. In order to be safe, physicians may have to collect random and repeat biopsies as the only possible way to ensure that cancer is not missed in high risk patients.

Blue Light

Because of the limitations with using white light for visualizing cancers, various companies have begun to explore usage of blue light in conjunction with imaging agents or chemical dyes. These recent advances and successes with blue light and chemical tumor targeting agents have improved the ability to visualize cancers and margins.

However, these chemical agents can cause various adverse effects including anaphylaxis shock and hypersensitivity reactions with repeated usage at the high doses currently required for visualization. It is for this reason that the FDA has limited use to just once for any patient.

Doctors and surgeons cannot repetitively examine a patient with these chemical imaging agents. This is as critical problem for patients with multiple tumors and those with recurrent tumors.

Red Light

Red light requires specialized laser light sources, ultrasensitive cameras and a unique optical design. Currently no commercial instruments are available using red light.

The Unmet Need

What is acutely needed in this particular imaging space is an ultrasensitive endoscope system that uses white light while simultaneously using other wavelengths of light to visualize all tumors, and one that requires only a fraction of the chemical imaging agent so as to reduce the toxicity allowing multiple usage in patents.

Future endoscopes should also have more advanced cancer detection technologies so that ultimately nochemical imaging agents would be necessary, and these future tools should provide ultrasensitive and advanced imaging capabilities.