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As the Director of the Gastrointestinal Endoscopy Program at Massachusetts General Hospital, my research has focused on the early diagnosis of pancreatic cancer.Our program has developed a variety of endoscopic techniques to aspirate malignant and pre-malignant lesions of the pancreas. These lesions include cystadenomas, intra-ductal tumors, and masses.We have worked closely with collaborators in the MGH Departments of Cytology and Chemistry to develop assays for tumor markers and cytologic analysis that are capable of making a tissue diagnosis of a mucinous cystadenoma and detecting early evidence of malignant degeneration.Recently, we have established an endoscopic technique for the diagnosis of early malignancy of the esophagus, often in the setting of Barrett's esophagus. Endoscopic confocal laser microscopy is a new technique for providing histologic quality imaging of the mucosa. We are participating in a national study for establishing the sensitivity and specificity of confocal laser microscopy in Barrett's esophagus.
My clinical research program focuses on the early detection of gastrointestinal malignancy using advanced endoscopic techniques. Using endoscopic confocal microscopy, we will compare the diagnostic accuracy of traditional endoscopy with mucosal resection to confocal microscopy in patients with high risk lesions arising from Barrett's esophagus. This clinical research program will be conducted in the context of a national prospective multicenter trial (CEBE). We also have a protocol to determine the diagnostic accuracy of confocal microscopy in differentiating between adenomatous and inflammatory polyps.
We will also use advanced endoscopic techniques for the detection of early pancreatic malignancy arising from cystic lesions of the pancreas. Endoscopic ultrasound is used to guide fine needle aspiration and optical coherence tomography (OCT) imaging. A variety of cyst fluid markers are used to enhance the diagnostic accuracy of EUS imaging alone. We have examined the accuracy of CEA and cytology in the diagnosis of mucinous cystic lesions. Currently we are investigating new molecular markers. OCT imaging is performed using a novel catheter placed within a EUS needle and guided into a cystic lesion.
Current research projects within the CIST Center and the Pancreas and Biliary Program:
We are currently directing several clinical trials, including an investigation of in vivo confocal endomicroscopy in the diagnosis of Barrett's esophagus and a pilot study of endoscopic radiofrequency ablation of malignant bile duct strictures (visit the Clinical Trials website of the National Institutes of Health for more information).
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