Fluorescence-guided endoscopy and surgery: Clinical applications for optical imaging agents

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    The current gold standard for the detection of solid cancers of the gastrointestinal tract is high-definition white-light endoscopy. However, the morphological characteristics and epithelial changes that characterize the precursor lesions of these tumors are often subtle and difficult to differentiate from surrounding, healthy tissue. Moreover, a tumor-free resection margin is crucial for the prognosis and survival of a patient. However, during surgery a surgeon is solely dependent on visual and tactile inspection for the differentiation between tumor and non-tumor tissue.

    Fluorescence imaging is a novel and emerging technique that generates contrast by visualizing the biomarker expression levels that become upregulated during the course of a disease, using targeted fluorescently-labelled imaging agents. Consequently, this technique has the potential to serve as a ‘red-flag’ endoscopic or intraoperative imaging modality that may enable a better differentiation between (pre)malignant lesions and surrounding, healthy tissue.

    This thesis describes the clinical application of fluorescence imaging for the improved visualization of solid tumors of the gastrointestinal tract. By combining conventional endoscopy with fluorescence endoscopy, the early detection of the precursor lesions of esophageal cancer and colorectal polyps might be improved. In addition, fluorescence-guided surgery enables ‘real-time’ feedback on the location and resection margins of a tumor during surgery of head-and-neck cancer, peritoneal carcinomatosis of colorectal origin and locally advanced rectal cancer patients. The first results of fluorescence-guided endoscopy and surgery are very promising and support future research on this technique.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • Weersma, Rinse, Supervisor
    • van Dam, Go, Supervisor
    • Nagengast, Wouter, Co-supervisor
    Award date2-Sept-2020
    Place of Publication[Groningen]
    Print ISBNs978-94-034-2787-4
    Electronic ISBNs978-94-034-2788-1
    Publication statusPublished - 2020

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