All our consultants are research active. This means that they participate and run research studies. Professor Lovat is the head of the research department for tissue and energy at UCL
This is a UK-wide registry of all patients being treated with HALO radiofrequency ablation (RFA) for dysplasia (pre-cancerous changes) and early cancer in Barrett‟s oesophagus. HALO RFA is a safe and effective minimally-invasive therapy for these patients. It can be delivered through an endoscope, removing the need for surgery. It has recently been recommended by NICE. UCL Hospitals runs this registry for the whole country, and over 1,000 patients have already been recruited nationwide. We have published the first results of this study, and the results are very favourable, showing a high early success rate. We are now collecting long-term outcome data so that we can be certain of the enduring benefits of this therapy.
Our colleagues in Cambridge have developed a screening test for Barrett’s oesophagus. This involves participants swallowing a capsule on a string just before they have an endoscopy. Inside the capsule is a little sponge which pops out when the capsule reaches the stomach. The sponge is then removed through the mouth. It is covered with cells from the lining of the oesophagus, which can then be tested. The procedure is simple and painless. Eventually, we hope to use this to screen the entire British population for risk of developing oesophageal (gullet) cancer. For now, we are developing this device so that it will be able to accurately categorise cancer risk for individual patients. To do this we use different molecular tests applied to cells collected by the sponge device. The study is a „case-control‟ study design in which the cases are patients with known Barrett‟s oesophagus, and controls are individuals with reflux or indigestion (dyspepsia) symptoms referred for endoscopy. The main UK centres with expertise in Barrett’s oesophagus have recruited most of the 1,000 patients who have taken part in this study. These include UCL Hospitals, Cambridge, Nottingham and Newcastle. This work was funded by Cancer Research UK.
This is an exciting and new area of research. We have started early experiments using the unique characteristics of mid infra-red spectroscopy and using Barrett’s oesophagus tissue to analyse unique characteristics that would help differentiate them from normal tissue. We are starting to show that we can accurately detect not only Barrett’s oesophagus tissue but high grade dysplasia, using the specific mid infra-red spectral signatures of each tissue type.
It has already been shown that when cells start to display abnormal histological characteristics and dysplasia, there is a direct correlation with the amount of DNA content within them. This abnormal DNA content, called aneuploidy, can identify those at risk of progression to cancer. We have state-of-the-art equipment that can easily detect this change, and we have been using it for years to establish which patients are most at risk, and tailoring their surveillance and therapy accordingly. We are using this established tool to study new biomarkers which will help us strengthen the test by which we can identify those at risk.
The development of pre-cancerous and cancerous changes in patients such as those with Barrett’s oesophagus is thought to be associated with defects in the genes that control the cell cycle, and ultimately cell proliferation and death. There are specific identified molecules that regulate the cell’s progression through the cell cycle, and abnormalities in these have been shown to be associated with dysplasia and cancer in Barrett’s oesophagus. We have undertaken experiments identifying a selection of these cell cycle markers, and are currently in the process of conducting a larger series of experiments to confirm that there is a potential association. This could provide a new and easy to use tool for not only detecting areas of dysplasia, but also contributing to existing biomarkers to help strengthen the way in which we can predict cancer risk in patients.