Esophageal cancer is among the deadliest cancers, with survival rates of only about 10% when detected late. In contrast, early-stage detection can result in survival rates of up to 90%. Now, a new imaging approach enables earlier identification of changes in esophageal tissue, allowing detection of precancerous and malignant stages that were previously difficult to visualize.

Researchers at Helmholtz Munich (Munich, Germany) have developed O2E, a capsule-based endoscopy system combining optical coherence tomography and optoacoustic imaging. Optical coherence tomography captures tissue structures, while optoacoustic imaging uses light pulses to detect ultrasound signals from deep tissue blood vessels. Together, they generate high-resolution 3D images of esophageal structure and function, with sensors scanning tissue in a 360-degree view.

In a pilot study, the team examined the esophagus of animals and patient tissue samples with Barrett’s esophagus, a precursor to cancer. They identified clear differences between healthy, abnormal, precancerous, and malignant tissues. Proof-of-principle tests were also conducted on a volunteer’s inner lip, which shares similar tissue characteristics with the esophagus.

Building on these results, the researchers will refine the capsule for clinical use. The team plans to integrate confocal endo-microscopy for high-resolution, real-time imaging of cellular structures, enabling the targeting of specific molecular cancer markers. This could reduce the need for multiple biopsies and accelerate diagnostics.

The technology promises both patient and economic benefits, potentially lowering treatment costs for advanced cancer with early detection. The researchers aim to validate the device ahead of a future market launch, with the ultimate goal of improving survival and reducing healthcare costs.

“We also plan to integrate confocal endo-microscopy — a technique that provides high-resolution, real-time visualization of cellular structures — to enable more detailed analysis during examinations,” said Dr. Qian Li, first author of the study. “This could pave the way for high-resolution endoscopic molecular imaging, allowing us to target specific molecular markers in cancer.”

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