Real-time microscopic evaluation of gastrointestinal tissue at cellular level during endoscopy shows promise for digestive disease patients

A novel endoscopic, high-resolution, imaging technology may revolutionize the practice of gastroenterology (GI) via the application of a laser to examine diseased tissue in the GI tract.

Confocal laser microendoscopy has recently been available at Mayo Clinic in Arizona, and initial results suggest that this technology may reduce the number of biopsies required to establish a digestive disease diagnosis. The laser technology allows the endoscopists to perform microscopic examination of the gastrointestinal mucosal layer during endoscopy.

This microscopic view of the lining of the digestive tract would otherwise be available only to the pathologist using a microscope to examine biopsy samples. The key advantages are real-time results, leading to potential early diagnosis of gastrointestinal cancers. Also, the more sub-surface, cellular-level imaging can be helpful in targeting biopsies of relevant areas and can potentially uncover microscopic diseases such as colitis or Helicobacter pylori.

This new technology can potentially enhance the endoscopist's ability to detect subtle, early disease in a real-time fashion and manage such lesions during the same endoscopic procedure by application of techniques, such as endoscopic resection of superficial cancers. In the confocal laser microendoscopy procedure, a small, laser-based microscope is advanced through a catheter or endoscopy tube to the evaluation site. A small amount of fluorescent dye is administered intravenously, and, when activated by the laser, emits light of various wavelengths. A series of rotation mirrors direct the laser across the tissue sample and the visuals are transmitted to a nearby display screen, allowing physicians to see real-time images of cells and sub-cellular structures with 500 to 1,000 times greater magnification than the conventional endoscopic image.

"This new advance shows significant promise to improve the diagnosis of a range of gastrointestinal diseases and has potential to improve the detection rate of cancers," say Cuong C. Nguyen, M.D., and Ananya Das, M.D., Division of Gastroenterology. "Being able to go to the deep, subcellular levels, where other imaging or biopsy methods have not gone previously, could eliminate unnecessary biopsies and potentially lead to earlier detection of cancers and other gastrointestinal pathology in patients."

(Source: Mayo Clinic: July 2008)