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Research & Development

€4m project to speed diagnosis of esophageal cancer

14 Mar 2017

European ESOTRAC project to develop optoacoustic endoscope for earlier diagnosis of this common cancer.

The Institute of Biological and Medical Imaging at Helmholtz Zentrum München, Germany, is heading a research project entitled ”Hybrid optical and optoacoustic endoscope for esophageal tracking” or ESOTRAC. This four-year, €4 million, pan-European project will bring together engineers and physicians to develop a novel hybrid endoscopic instrument for early diagnosis and staging of esophageal cancer.

The finished device is expected to reduce the number of unnecessary biopsies and, importantly, facilitate early-disease detection leading to earlier start of therapy, which will improve therapeutic efficacy over late-disease treatment and, ultimately, cost-savings for health care systems. ESOTRAC was awarded the €4 million by Horizon 2020, the EU framework program for research and innovation.

With more than 450,000 new cases per year and a five-year survival rate of only ten percent when diagnosed late, esophageal cancer (EC) is the sixth-leading cause of cancer-related deaths. Currently it is detected using white-light endoscopy or by random tissue biopsies, followed by histopathological analysis of excised tissue. Due to limitations of the current detection methods, EC is typically detected at an advanced stage, which is treated surgically and typically attains poor survival prognosis.

The ESOTRAC program is designed to bring together engineers and physicians, with the aims of significantly improving the detection of early-stage EC. The interdisciplinary, five-country research team (Germany, UK, France, Austria, Denmark) will develop, what the project specification describes as: “An innovative endoscope that combines sensing of pathophysiological tissue signatures resolved by multi-spectral optoacoustic (photoacoustic) tomography (MSOT) with morphological disease signatures provided by optical coherence tomography (OCT)”.

The resulting system is planned to operate in label-free mode and, due to its tomographic ability, visualize sub-surface tissue features, providing superior information of the esophageal wall compared to conventional video endoscopes. This comprehensive sub-surface information is expected to detect early-stage EC and enable disease staging – neither of which can be done reliably today. The proposed endoscope could also be useful in reducing the number of unnecessary biopsies performed by providing more accurate guidance to suspicious areas over white-light endoscopy.

3D imaging

The device developed by ESOTRAC is also expected to change the landscape of gastroenterological endoscopy – beyond the diagnosis of EC – by allowing rapid three-dimensional imaging of the entire esophageal wall as well as quantitation of disease biomarkers.

“The combination of MSOT and OCT can shape the way physicians look at the esophagus in the near future,” said Prof. Vasilis Ntziachristos, ESOTRAC Coordinator, director of the Institute of Biological and Medical Imaging at Helmholtz Zentrum München and Professor and Chair of Biological Imaging at the Technical University of Munich.

“From a clinical perspective we desperately need new technologies that improve imaging and combine information on molecular markers for early detection of disease and this research is trying to do exactly that” said Prof. Rebecca Fitzgerald, a world-leading clinical expert in esophageal cancer and lead physician at the MRC Cancer Unit at the Cambridge Biomedical Campus in the UK, one of the ESOTRAC partners.

Since one of the goals of ESOTRAC is to offer quantitative metrics of EC disease, toward personalized and precision medicine, the device may help equalize the quality of endoscopy-based care in rural and urban settings. The ESOTRAC endoscope will also be built to be as small and patient-friendly as possible, reducing the risk of gag reflex and therefore the need for sedation.

By these means, ESOTRAC aims to create an endoscope that can be widely deployed in gastroenterology clinics. At the same time, the lessons learned in building the ESOTRAC endoscope may help guide the design of next-generation imaging devices for the other body cavities, including the colon.


The ESOTRAC consortium partners are as follow:

  • Helmholtz Zentrum München (Coordinator) – Germany
  • Amplitude Systemes SA – France
  • Ascenion GmbH – Germany
  • Denmarks Tekniske Universitet – Germany
  • Medizinische Universität Wien – Austria
  • Rayfos LTD – United Kingdom
  • Sonaxis SA - France
  • Statice SAS - France
  • University of Cambridge– United Kingdom

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