Interventionelle ERCP bei Patienten mit Cholestase: Häufigkeit und Antibiotikaresistenz der biliären Keimbesiedlung

Interventional ERCP in patients with cholestasis. Degree of biliary bacterial colonization and antibiotic resistance. Biliary obstruction together with bacterial colonization of the bile duct may lead to development of acute cholangitis. The aim of our prospective study was to investigate the presence and degree of biliary bacterial colonization by means of bile aspiration during ERCP in patients with biliary obstruction. Furthermore, we evaluated antibiotic therapy regimens, which would cover the bacterial species obtained by ERCP and subsequent culture in each patient. In addition, analysis of risk factors was performed that would predispose to the development of cholangitis.80 patients w…

Chromoendoscopy in Inflammatory Bowel Disease

Chromoendoscopy with methylene blue or indigo carmine significantly increases the diagnostic yield of finding intraepithelial neoplasia in patients with longstanding colitis. The number needed to treat is 14 for panchromoendoscopy to identify 1 additional patient with dysplasia. Chromoendoscopy can greatly facilitate the identification of flat lesions harboring intraepithelial neoplasia. Chromoendoscopy can guide biopsies and clearly reduces the amount of biopsies that are needed per patient. Magnifying endoscopy or CLE are additional techniques, which can be used in conjunction with chromoendoscopy to further reduce the amount of biopsies and to further increase the diagnostic yield. Chrom…

Endomicroscopy for a reliable diagnosis of colorectal neoplasia

The modern colonoscopist faces two problems: identifying all relevant lesions and then making an appropriate risk assessment of the detected lesions. The latter is crucial for determining patient outcome. A feasibility study suggests that a new endomicroscopy technology could greatly improve the detection and assessment of neoplastic colorectal lesions.

Is chromoendoscopy the new standard for cancer surveillance in patients with ulcerative colitis?

Chromoendoscopy was introduced in 2003 as a novel 'red flag' technique that aimed to increase the sensitivity of identifying flat, neoplastic lesions in patients with ulcerative colitis. The improved sensitivity of chromoendoscopy over standard white-light endoscopy has been confirmed in European and Asian centers. This commentary discusses the findings from a prospective, controlled study from the Mount Sinai Hospital in New York. The findings of this study provide unequivocal evidence that chromoendoscopy is superior to white-light endoscopy in the detection of neoplasias in patients with IBD. The authors of this study identified a greater number of lesions and a higher number of patients…

Chromoscopy-Guided Endomicroscopy Increases the Diagnostic Yield of Intraepithelial Neoplasia in Ulcerative Colitis

Background & Aims: Because of the large number of biopsy specimens, surveillance colonoscopy in ulcerative colitis (UC) is currently time consuming and significant flat lesions still may be missed. In this study we assessed the value of combined chromoscopy and endomicroscopy for the diagnosis of intraepithelial neoplasias in a randomized controlled trial. Methods: A total of 161 patients with long-term UC in clinical remission were randomized at a 1:1 ratio to undergo conventional colonoscopy or chromoscopy with endomicroscopy. Eight patients were excluded because of insufficient bowel preparation. In the conventional colonoscopic group (n = 73), random biopsy examinations and targeted bio…

The learning curve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions.

Background: The endoscope-based confocal laser endomicroscopy (eCLE) system allows in vivo imaging of colorectal epithelium. Little is known about the learning curve for accurate interpretation of confocal images acquired with eCLE. Objective: To determine the learning curve of eCLE, its diagnostic accuracy, and the intra- and interobserver agreement for the differentiation of colorectal lesions. Design: Post hoc assessment of selected eCLE images. Setting: Academic centers. Patients: This study involved colonoscopic images from 47 patients. Main Outcome Measurements: Learning curve of eCLE, accuracy, and intraobserver and interobserver agreement. Methods: Three endoscopists received a shor…

Local barrier dysfunction identified by confocal laser endomicroscopy predicts relapse in inflammatory bowel disease

Objectives: Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods: Confocal endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal endomicroscopy in humans was devise…

Common variants in the HLA-DQ region confer susceptibility to idiopathic achalasia

Idiopathic achalasia is characterized by a failure of the lower esophageal sphincter to relax due to a loss of neurons in the myenteric plexus(1,2). This ultimately leads to massive dilatation and an irreversibly impaired megaesophagus. We performed a genetic association study in 1,068 achalasia cases and 4,242 controls and fine-mapped a strong MHC association signal by imputing classical HLA haplotypes and amino acid polymorphisms. An eight-residue insertion at position 227-234 in the cytoplasmic tail of HLA-DQ beta 1 (encoded by HLA-DQB1*05:03 and HLA-DQB1*06:01) confers the strongest risk for achalasia (P = 1.73 x 10(-19)). In addition, two amino acid substitutions in the. extracellular …

Endoluminal therapy of GERD with a new endoscopic suturing device

Background Endoscopic, endoluminal therapy might be an alternative treatment option in light of the costs of proton pump inhibitor therapy and possible complications after laparoscopic surgery. The aim of the current study was to assess the efficacy and the safety of a new endoluminal suture device (ESD) in pig models and humans. Secondly, 3 and 6 months' follow-ups were performed, and possible complications and their management were evaluated. Methods In the preclinical phase of the study, suturing procedures were practiced and evaluated in 8 pig models (Erlanger Endo Trainer). In the clinical phase, 20 patients with mild esophagitis, small or no hiatal hernia, and signs of abnormal acid e…

Endoscopic detection of early lower gastrointestinal cancer

The prognosis for patients with malignancies of the lower gastrointestinal tract is strictly dependent on early detection of premalignant and malignant lesions. What should an ideal screening and surveillance colonoscopy be able to accomplish? The technique should allow detection of large but also discrete mucosal alterations. Ideally, endoscopic discrimination between neoplastic and non-neoplastic lesions would be possible during the ongoing procedure. At present, endoscopy can be performed with powerful new endoscopes. Comparable to the rapid development in chip technology, the optical features of the newly designed endoscopes offer resolutions, which allow new surface details to be seen.…

High-definition endoscopy with i-Scan and Lugol’s solution for more precise detection of mucosal breaks in patients with reflux symptoms

BACKGROUND AND STUDY AIMS: Patients with gastroesophageal reflux disease are subdivided into non-erosive (NERD) and erosive reflux disease (ERD). The newly available EPKi processor enables high-definition resolution above HDTV standard (HD+). The aim of the study was to test the efficacy of HD+ esophagogastroduodenoscopy alone and in conjunction with i-Scan (newly developed postprocessing digital filter) and chromoendoscopy (Lugol’s solution) for differentiation of reflux patients. METHODS: The distal esophagus of patients with heartburn was inspected with three imaging modalities. HD+ was followed by i-Scan and 15-mL Lugol’s solution (1.5 %). The esophagus was evaluated for mucosal breaks …

Tonnenkonkremente im Ductus choledochus bei einer 4 Jahre vergessenen, impaktierten Endoprothese

We report on a 67-year-old female patient who presented in July 2005 with sudden onset of pain in the right upper abdomen. The patient had undergone cholecystectomy in 1987. Because of recurrrent complaints in the right upper abdomen, a pigtail stent was placed into the common hepatic duct in 2001. When the patients presented now, the laboratory tests including liver enzymes were within normal ranges. Endoscopic retrograde cholangiogi aphy, however, revealed a remaining 10-French, impacted double pigtail endoprothesis that was obstructed by sludge as well as multiple giant bile duct stones of 20 to 30 mm in size. The giant stones could be finally removed by the combined use of ESWL and endo…

In vivo real-time imaging of the liver with confocal endomicroscopy permits visualization of the temporospatial patterns of hepatocyte apoptosis.

Apoptosis is a dynamic process of programmed cell death and is involved in multiple diseases. However, its mechanisms and sequence of events are still incompletely understood, partly because of the inability to visualize single cells continuously in vivo. The aim of the present study was to monitor hepatocyte apoptosis with confocal endomicroscopy in living rodents. In 73 anaesthetized mice, apoptotic liver injury was induced by injection of the CD95-agonistic antibody Jo2. Individual hepatocytes were followed for up to 240 min with a handheld confocal probe (FIVE1; Optiscan) providing 0.7 μm resolution (1,000-fold magnification). Different fluorescence staining protocols were used for cell…

Verbessert die Therapie mit Levofloxacin die Helicobacter-pylori-Eradikation?

Novel Colonoscopic Imaging

Surveillance colonoscopy in ulcerative colitis: magnifying chromoendoscopy in the spotlight

Chromoendoscopy in ulcerative colitis may offer the possibility of detecting dysplastic or neoplastic changes at a curable stage, and thus expand the indication for chromoendoscopy from screening to surveillance colonoscopy Colonoscopy is the gold standard for colorectal cancer screening.1–3 Detection and complete removal of adenomas disrupt the adenoma-carcinoma sequence and thus prevent the development of colorectal cancer. However, endoscopists still fear that they may have overlooked relevant lesions despite the availability of modern videoendoscopes. This problem is underlined by a relatively high rate of adenomas missed by conventional endoscopy (up to 27%), as determined by back to b…

New imaging techniques and opportunities in endoscopy.

Gastrointestinal endoscopy is undergoing major improvements, which are driven by new available technologies and substantial refinements of optical features. In this Review, we summarize available and evolving imaging technologies that could influence the clinical algorithm of endoscopic diagnosis. Detection, characterization and confirmation are essential steps required for proper endoscopic diagnosis. Optical and nonoptical methods can help to improve each step; these improvements are likely to increase the detection rate of neoplasias and reduce unnecessary endoscopic treatments. Furthermore, functional and molecular imaging are emerging as new diagnostic tools that could provide an oppor…

Obere gastrointestinale Blutung mit hämorrhagischem Schock am Ende einer Urlaubsreise: Präklinische und innerklinische Versorgung eines gastrointestinalen Notfalls

ZusammenfassungNach der Rückkehr aus dem Urlaub wurde ein 55-jähriger Patient mit Teerstuhl und hämorrhagischem Schock im Zugabteil eines InterCity der Deutschen Bahn notfallmedizinisch versorgt und in ein Krankenhaus der Maximalversorgung eingeliefert. Hier erfolgte zunächst die weitere notfallmedizinische Behandlung, in deren Rahmen in der internistischen Notaufnahme in interdisziplinärer Zusammenarbeit eine Stabilisierung der Hämodynamik sowie die Sicherung der Atemwege und Atemfunktion erfolgten. Anschließend wurde eine Notfall-Endoskopie des oberen Gastrointestinaltrakts durchgeführt. Ursächlich für das hämorrhagische Schockgeschehen war eine arteriell spritzende, endoskopisch nicht zu…

Review article: in vivo imaging by endocytoscopy

Aliment Pharmacol Ther 2011; 33: 1183–1193 Summary Background  Endocytoscopy (EC) enables in vivo microscopic imaging at 1400-fold magnification, thereby allowing the analysis of mucosal structures at the cellular level. In contrast to fluorescence imaging with confocal laser endomicroscopy which allows analysis of mucosal structures up to 250 μm in depth, EC is based on the principle of contact light microscopy and only allows visualisation of the very superficial mucosal layer. Aim  To systematically review the feasibility and diagnostic yield of EC for in vivo diagnosis of diseases. Methods  A systematic search of the literature on diagnostic interventions in the gastrointestinal tract u…

Acetic acid compared with i-scan imaging for detecting Barrett's esophagus: a randomized, comparative trial.

Background Traditional surveillance in patients with Barrett's esophagus (BE) has relied on random biopsies. Targeted biopsies that use advanced imaging modalities may significantly improve detection of specialized columnar epithelium (SCE). Objective We compared the efficacy of targeted biopsies that used i -scan or acetic acid to random biopsies in the detection of SCE. Design Patients with visible columnar lined epithelium or known BE were randomized at a 1:1 ratio to undergo acetic acid application or i -scan with targeted biopsies. Setting Targeted biopsies were performed based on surface architecture according to the Guelrud classification followed by 4-quadrant biopsies. Patients A t…

Intraprocedural bowel cleansing with the JetPrep cleansing system improves adenoma detection.

AIM: To investigate the impact of JetPrep cleansing on adenoma detection rates. METHODS: In this prospective, randomized, crossover trial, patients were blindly randomized to an intervention arm or a control arm. In accordance with the risk profile for the development of colorectal carcinoma, the study participants were divided into high-risk and low-risk groups. Individuals with just one criterion (age > 70 years, adenoma in medical history, and first-degree relative with colorectal cancer) were regarded as high-risk patients. Bowel preparation was performed in a standardized manner one day before the procedure. Participants in the intervention arm underwent an initial colonoscopy with sta…

Molecular imaging of VEGF in gastrointestinal cancer in vivo using confocal laser endomicroscopy

Vascular endothelial growth factor (VEGF) is a therapeutic target in gastrointestinal cancer (GiC). However, its in vivo visualisation could not be achieved to date with endoscopic techniques. Confocal laser endomicroscopy (CLE) is a novel imaging technique for gastrointestinal endoscopy providing in vivo microscopy at subcellular resolution. The aim of the study was to evaluate CLE for in vivo molecular imaging of VEGF in GiC.Molecular imaging of tumours in APCmin mice, in xenograft models and in surgical specimens of patients with colorectal cancer (CRC) was achieved after application of labelled antibodies. The tumour sites were scanned with the probe for the strongest specific fluoresce…

Mo1521 Endomicroscopy: Interobserver Agreement and Accuracy in Prediction of Intraepithelial Neoplasia in the Upper and Lower GI-Tract

Dépistage et diagnostic précoce du cancer colorectal

Qu’est-on en droit d’attendre d’une methode ideale de depistage et de surveillance par coloscopie? La technique doit permettre la detection d’importantes lesions mais aussi de discretes alterations muqueuses. Idealement, la distinction endoscopique entre lesion neoplasique et non neoplasique devrait etre possible en cours d’examen. Actuellement, l’endoscopie peut etre realisee avec de nouveaux endoscopes plus puissants. Parallelement au developpement rapide des puces electroniques, les caracteristiques optiques des nouveaux endoscopes offrent des resolutions qui permettent de voir de nouveaux details de la surface muqueuse. En complement de la chromo-endoscopie, les nouveaux videocoloscopes…

Confocal laser endomicroscopy.

A miniaturized confocal microscope was developed that could be integrated in the distal tip of a conventional colonoscope. With this technique, denoted confocal endomicroscopy, subsurface analysis of the gut mucosa and in-vivo histology during ongoing endoscopy are possible in full resolution by point scanning laser analysis. The diagnostic spectrum of confocal endomicroscopy is expanding from screening and surveillance for colorectal cancer to Barrett's esophagus, Helicobacter pylori-associated gastritis, and gastric cancer. The new detailed images seen with confocal laser endomicroscopy allow a unique look on cellular structures at and below the surface of the gut. This review describes t…

Methylene blue–aided cholangioscopy unravels the endoscopic features of ischemic-type biliary lesions after liver transplantation

Chromoendoscopy in Barrett's oesophagus: is cresyl violet the magic bullet?

The endoscopic detection of Barrett’s epithelium remains challenging even for modern endoscopy. This is mainly due to the fact that Barrett’s epithelium is often patchy and can easily be overlooked by conventional endoscopy with random biopsies. Thus, chromoendoscopy and magnifying endoscopy were introduced to facilitate diagnosis of Barrett’s epithelium and Barrett’s associated neoplasias. Methylene blue-aided chromoendoscopy was firstly introduced by Canto et al. [1]. The authors could show that methylene blue selectively stains specialised columnar epithelium, which is pathognomonic for Barrett’s epithelium. In contrast, dysplastic areas revealed no or weaker staining due to changes in t…

Current practice in managing patients on anticoagulants and/or antiplatelet agents around the time of gastrointestinal endoscopy -- a nation-wide survey in Germany.

Anticoagulants and antiplatelet agents are widely used in the prophylaxis and management of thromboembolic and cardiovascular diseases. Gastrointestinal bleeding is a well-known complication of these agents. Modification of anticoagulant and antiplatelet therapy is often required in patients undergoing surgical procedures and specific recommendations for the perioperative period have been issued. Fewer data exist with regard to the use of these agents around the time of endoscopic procedures. A survey of the American Society for Gastrointestinal Endoscopy (ASGE), performed several years ago, showed a wide variation between endoscopists in the management of anticoagulants and antiplatelet ag…

Confocal Laser Endomicroscopy and Chromoendoscopy - A New Option of Surveillance in Patients with Ureterosigmoidostomy or Rectosigmoid Pouch

Purpose In patients with bladder exstrophy-epispadias-complex (BEEC) or in selected patients with bladder loss for other reasons, ureterosigmoidostomy (USIG) & rectosigmoid pouch (Mainz Pouch (MZP) II) has been used at our institution. This diversion carries a lifelong risk for secondary malignancies. Therefore annual colonoscopy is recommended. Identification of potentially malignant structures can be challenging, and biopsies are taken in doubt, with the risk of injuring the ureterocolic implantation site. Using confocal laser endomicroscopy (CLE) and chromoendoscopy, the uretero-intestinal anastomosis is better visualized compared to conventional colonoscopy, and target biopsies could be…

6-thioguanosine diphosphate and triphosphate levels in red blood cells and response to azathioprine therapy in Crohn's disease.

Background & Aims: Azathioprine is the gold standard for immunosuppressive therapy in Crohn's disease (CD) and its molecular mechanism of action is caused by the metabolite 6-thioguanosine triphosphate (TGTP). In this study we assessed the impact of TGTP levels for monitoring of azathioprine therapy. Methods: A novel, highly sensitive assay was established to measure levels of TGTP and its precursors 6-thioguanosine monophosphates and 6-thioguanosine diphosphates (TGDP) in red blood cells from 50 CD patients. The results were correlated with clinical outcome. Results: TGTP levels could be quantified in 47 patients and a subgroup of these patients showed significantly high levels of TGDP. 6-…

Introduction From the New Editors for Imaging and Advanced Technology

Magnifying chromoendoscopy: Effective diagnostic tool for screening colonoscopy

Novel imaging modalities in the detection of oesophageal neoplasia.

The prognosis of oesophageal neoplasia is dependent on the stage of the disease at the time of detection. Early lesions have an excellent prognosis in contrast to more advanced stages that usually have a dismal prognosis. Therefore, the early detection of these lesions is of the utmost importance. In recent years, several new techniques have been introduced to improve the endoscopic detection of early lesions. The most important improvement, in general, has been the introduction of high-resolution/high-definition endoscopy into daily clinical practice. The value of superimposing techniques such as chromoendoscopy, narrow band imaging and computed virtual chromoendoscopy onto high-resolution…

Use of a Duodenoscope in the Management of a Ureteral Calculus in a Patient with Ureterosigmoidostomy (Mainz Pouch II; Rectosigmoid Pouch)

Sa1611 Computer-Assisted Diagnosis of Confocal Laser Endomicroscopy (CLE) by a Novel Image Analysis and Semantic Annotation Method

In vivo confocal laser endomicroscopy of the human liver: a novel method for assessing liver microarchitecture in real time

Background and study aims Confocal endomicroscopy is a unique novel tool for in vivo histology in humans. Due to limitations imposed by the form of the equipment and by sterilization workflows, its use has been limited to the gastrointestinal tract so far. We have developed a rigid miniaturized probe for confocal endomicroscopy of the human liver during laparoscopy. Patients and methods To assess the feasibility and potential clinical value of this new system (diameter 6.3 mm), 25 patients with liver disease were examined during routine minilaparoscopy under conscious sedation. Results Subsurface serial images (from surface to 250 microm) were generated in real time after fluorescein inject…

The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract

Aliment Pharmacol Ther 31, 548–552 Summary Background  Confocal laser endomicroscopy (CLE) is rapidly emerging as a valuable tool for gastrointestinal endoscopic imaging. Fluorescent contrast agents are used to optimize imaging with CLE, and intravenous fluorescein is the most widely used contrast agent. Fluorescein is FDA-cleared for diagnostic angiography of the retina. For these indications, the safety profile of fluorescein has been well-documented; however, to date, fluorescein is not cleared for use with CLE. Aims  To estimate the rate of serious and total adverse events attributable to intravenous fluorescein when used for gastrointestinal CLE. Methods  We performed a cross sectional…

In Vivo Imaging of Enteric Neuronal Networks in Humans Using Confocal Laser Endomicroscopy

Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy.

Background & Aims: Confocal laser endomicroscopy enables subsurface microscopic imaging of living tissue during ongoing endoscopy. This case report describes the in vivo detection of Helicobacter pylori by endomicroscopy.Methods: Endomicroscopy (Pentax, Tokyo, EC-3870CIFK) was performed by using two different contrast stains: Topical Acriflavine in addition to intravenously applied fluorescein netted the surface and allowed identification of focal accumulation of Helicobacter pylori at the surface and in deeper layer of the gastric epithelium. Biopsies were performed at the antrum and corpus for urease testing and histology. In addition, biopsies were cultured for Helicobacter pylori. Cultu…

Endoscopic assessment and grading of Barrett's esophagus using magnification endoscopy and narrow-band imaging: accuracy and interobserver agreement of different classification systems

Background: Three different classification systems for the evaluation of Barrett's esophagus (BE) using magnification endoscopy (ME) and narrow-band imaging (NBI) have been proposed. Until now, no comparative and external evaluation of these systems in a clinical-like situation has been performed. Objective: To compare and validate these 3 classification systems. Design: Prospective validation study. Setting: Tertiary-care referral center. Nine endoscopists with different levels of expertise from Europe and Japan participated as assessors. Patients: Thirty-two patients with long-segment BE. Interventions: From a group of 209 standardized prospective recordings collected on BE by using …

Antibodies against tumor necrosis factor (TNF) induce T-cell apoptosis in patients with inflammatory bowel diseases via TNF receptor 2 and intestinal CD14⁺ macrophages.

Background & Aims The anti–tumor necrosis factor (TNF) antibodies infliximab, adalimumab, and certolizumab pegol have proven clinical efficacy in Crohn's disease. Here, we assessed the effects of anti-TNF antibodies on apoptosis in inflammatory bowel disease (IBD). Methods CD14 + macrophages and CD4 + T cells were isolated from peripheral blood and lamina propria mononuclear cells from patients with IBD and control patients. Cell surface markers and apoptosis were assessed by immunohistology and fluorescence-activated cell sorting techniques. Results Lamina propria CD14 + macrophages showed significantly more frequent and higher membrane-bound TNF (mTNF) expression than CD4 + T cells in IBD…

Histologie in vivo avec endomicroscopie confocale dans le diagnostic des cancers colorectaux

L’endomicroscopie confocale constitue un nouvel outil diagnostique destine au diagnostic in vivo des modifications epitheliales constatees en cours de coloscopie. Apres l’application d’agents fluorescents, la technique permet d’obtenir en temps reel, une imagerie de la surface muqueuse et de la couche sous-muqueuse sous microscopie a haute resolution.

Chromoendoscopy and Magnifying Endoscopy in Patients with Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is common in the Western world. Upper endoscopy is needed to characterize the disease. Barrett’s esophagus as a complication of GERD is an established precancerous condition which can lead to adenocarcinoma in the distal esophagus. This review summarizes recent advances in the endoscopic characterization of Barrett’s esophagus using magnification endoscopy and chromoendoscopy. Methylene blue, indigo carmine and acetic acid are commonly used dyes to facilitate diagnosis of Barrett’s esophagus. Methylene blue is absorbed in the specialized columnar epithelium, which is pathognomonic for Barrett’s esophagus. Indigo carmine and acetic acid are used as cont…

Koinzidenz von Plattenepithelkarzinomen der Speiseröhre und Kopf-Hals-Karzinomen: Risiko und Früherkennung

Patients suffering from head and neck cancer (HNC) have or will develop a second esophageal squamous cell cancer (ESCC) in 5 - 14 %. When a second esophageal neoplasm occurs in a HNC patient, the prognosis is generally determined by the ESCC, and unfortunately it is poor. Prospective clinical studies in Japan, Brazil, Taiwan, France and Germany have shown that screening or surveillance using Lugol chromoesophagoscopy enables early detection of second esophageal neoplasias. Such a surveillance results in a survival benefit for HNC patients. Vice versa, ESCC patients also have a risk of 9.3 - 11.4 % for a head and neck cancer. Periodic otolaryngeal examination and pharyngoscopy is recommended…

Fluorescein- and EGFR-Antibody Conjugated Silica Nanoparticles for Enhancement of Real-time Tumor Border Definition Using Confocal Laser Endomicroscopy in Squamous Cell Carcinoma of the Head and Neck

Intraoperative definition of tumor free resection margins in head and neck cancer is challenging. In the current proof-of-principle study we evaluated a novel silica nanoparticle-based agent for its potential use as contrast enhancer. We synthesized silica nanoparticles with an average size of 45 nm and modified these particles with the fluorescence stain fluorescein isocyanate (FITC) for particle detection and with epidermal growth factor receptor (EGFR)-targeting antibodies for enhanced tumor specificity. The nanoparticles exhibited good biocompatibility and could be detected in vitro and in vivo by confocal laser scanning microscopy. Additionally, we show in an ex vivo setting that these…

P275 Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO score (the Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis

Endoscopic confocal imaging.

In vivo fluorescence endomicroscopy is a newly developed diagnostic tool enabling virtual in vivo histology of the mucosal layer during ongoing endoscopy. This review summarizes currently available data about the technique and clinical use of confocal endomicroscopy. Indications discussed include colorectal cancer evaluation, ulcerative colitis and surveillance, Barrett's esophagus, and detection of Helicobacter pylori infection in vivo.

Endoscopic mucosal resection: an evolving therapeutic strategy for non-polypoid colorectal neoplasia

Endoscopic management for laterally spreading tumours of the colorectum is a safe and effective treatment and may be an alternative to surgery in selected patients Colorectal cancer develops in approximately 5–6% of the adult population and is one of the leading causes of cancer death in Europe and the USA.1,2 Screening colonoscopy is the widely accepted gold standard for early diagnosis of colorectal cancer and should be offered to patients older than 50 years.3–5 However, colonoscopy is increasingly in competition with computed tomographic virtual endoscopy.6 Therefore, it is essential to understand whether total colonoscopy rather than virtual endoscopy enables the detection of all relev…

Chromoendoscopy with indigocarmine improves the detection of adenomatous and nonadenomatous lesions in the colon.

BACKGROUND AND STUDY AIMS Depressed early cancers and flat adenomas have a high potential for malignancy with possible infiltrating growth, despite the small size of the lesion. Japanese investigators have shown that early diagnosis and classification of these lesions is possible with the help of chromoendoscopy. The aim of this study, therefore, was to evaluate the usefulness of chromoendoscopy during routine colonoscopy. PATIENTS AND METHODS During routine colonoscopy, vital staining with indigocarmine solution (0.4 %, 1 - 10 ml) was performed on all visible lesions in 100 consecutive patients without visible inflammatory changes. If findings on macroscopic examination were unremarkable, …

In vivo endomicroscopy improves detection of Barrett’s esophagus–related neoplasia: a multicenter international randomized controlled trial

Background Confocal laser endomicroscopy (CLE) enables in vivo microscopic imaging of the GI tract mucosa. However, there are limited data on endoscope-based CLE (eCLE) for imaging Barrett's esophagus (BE). Objective To compare high-definition white-light endoscopy (HDWLE) alone with random biopsy (RB) and HDWLE + eCLE and targeted biopsy (TB) for diagnosis of BE neoplasia. Design Multicenter, randomized, controlled trial. Setting Academic medical centers. Patients Adult patients with BE undergoing routine surveillance or referred for early neoplasia. Intervention Patients were randomized to HDWLE + RB (group 1) or HDWLE + eCLE + TB (group 2). Real-time diagnoses and management plans were r…

An unmet medical need:advances in endoscopic imaging of colorectal neoplasia

Gastrointestinal cancer is a major public health problem worldwide. Detection of early neoplastic lesions in gastrointestinal tract is essential for cure, because prognosis and survival are related to the size and stage of malignant lesions. Endoscopic screening and treatment of polyps could prevent approximately 80% of colorectal cancer (CRC). However, white-light endoscopy is an imperfect technology since miss rates of up to 25% have been reported and polyps without malignant potential were treated without benefit but with additional costs and risks to the patient. There are several known "human" predictors of an inadequate colonoscopy. These include patient characteristics such as poor b…

The Barrett‐associated variants at GDF 7 and TBX 5 also increase esophageal adenocarcinoma risk

Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) represent two stages within the esophagitis-metaplasia-dysplasia-adenocarcinoma sequence. Previously genetic risk factors have been identified that confer risk to BE and EAC development. However, to which extent the genetic variants confer risk to different stages of the BE/EAC sequence remains mainly unknown. In this study we analyzed three most recently identified BE variants at the genes GDF7 (rs3072), TBX5 (rs2701108), and ALDH1A2 (rs3784262) separately in BE and EAC samples in order to determine their risk effects during BE/EAC sequence. Our data show that rs3072 at GDF7 and rs2701108 at TBX5 are also associated with EAC and …

Identification of epithelial gaps in human small and large intestine by confocal endomicroscopy.

Background & Aims: Confocal endomicroscopy is an emerging technology that poses the endoscopist with challenges for identifying epithelial structures in the human intestine. We have shown previously that the murine intestinal epithelium is punctuated by gaps caused by cell shedding. The goals of this study were to determine if confocal endomicroscopy could resolve the presence of human epithelial gaps and whether a proinflammatory cytokine could increase cell shedding. Methods: Intestinal mucosa was imaged after staining with acriflavine. Confocal endomicroscopy of 17 patients yielded 6277 images from the human terminal ileum and rectum. Results were validated by parallel studies of anesthe…

In vivo molecular and morphological imaging by real time confocal mini-microscopy

We evaluated a newly developed miniaturized confocal laser microscopy probe for real-time in vivo molecular and morphological imaging of normal, inflammatory, and malignant tissue in rodents. In the rigid mini-microscopy probe (diameter 7 mm), a single line laser delivers an excitation wavelength of 488 nm. Optical slice thickness is 7 μm, lateral resolution 0.7 μm. The range of the z-axis is 0 - 250 μm below the tissue surface. Organ systems were examined in vivo in rodent models of human diseases. FITC-labeled Lycopersion esculentum lectin was injected or selected cell populations stained for molecular targeting. Morphological imaging was performed using fluorescein sodium, FITC-labeled d…

Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps

Abstract Background Prediction of histology of small polyps facilitates colonoscopic treatment. The aims of this study were: 1) to develop a simplified polyp classification, 2) to evaluate its performance in predicting polyp histology, and 3) to evaluate the reproducibility of the classification by trainees using multiplatform endoscopic systems. Methods In phase 1, a new simplified endoscopic classification for polyps – Simplified Identification Method for Polyp Labeling during Endoscopy (SIMPLE) – was created, using the new I-SCAN OE system (Pentax, Tokyo, Japan), by eight international experts. In phase 2, the accuracy, level of confidence, and interobserver agreement to predict polyp hi…

WITHDRAWN: Defining In Vivo Mucosal Inflammatory Activity Using Laser Scanning Confocal Endomicroscopy in Human Ulcerative Colitis

This article has been withdrawn consistent with Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). The Publisher apologizes for any inconvenience this may cause.

Confocal Endomicroscopy Identifies Loss of Local Barrier Function in the Duodenum of Patients with Crohnʼs Disease and Ulcerative Colitis

Background: Increased cell shedding with gap formation and local barrier dysfunction can be identified endomicroscopically in the terminal ileum of patients with inflammatory bowel disease. We aim to evaluate whether these changes are also present in the duodenum of patients with inflammatory bowel disease. Methods: Fifteen patients with Crohn's disease (CD), 10 patients with ulcerative colitis (UC), and 10 controls underwent fluorescein-aided confocal laser endomicroscopy (CLE). CLE was performed on macroscopically normal antral and duodenal (D1, D2, D3, D4) mucosa. Representative CLE images were prospectively analyzed. Images were scored for the number of epithelial gaps, cell shedding, a…

Methylene blue-aided cholangioscopy in patients with biliary strictures: feasibility and outcome analysis

BACKGROUND AND STUDY AIMS: Chromoendoscopy using methylene blue is employed in the gastrointestinal tract to delineate neoplastic lesions. We tested the value of chromoendoscopy during choledochoscopy for characterization of local inflammation, neoplasias, and other alterations in patients with biliary strictures. METHODS: Patients with suspected biliary lesions were scheduled for endoscopic retrograde cholangiography with subsequent cholangioscopy. After initial inspection of the bile duct, 15 ml methylene blue (0.1 %) was administered via the working channel of the cholangioscope. Newly appearing circumscribed or unstained lesions were judged according to their macroscopic type and staini…

Endoscopic surveillance in ulcerative colitis: smart biopsies do it better.

Patients with ulcerative colitis (UC) have a significantly higher risk for the development of colitisassociated colorectal cancer. Endoscopic surveillance is recommended. The growth pattern of dysplastic tissue is often multifocal and flat. Thus, significant lesions might be overlooked. Multiple random biopsies are recommended, but cannot eliminate the possibility of missed cancers with severe consequences for the patient. Chromoendoscopy with methylene blue or indigo carmine can unmask flat lesions and may solve this problem. In addition, confocal laser endomicroscopy enables in vivo histology with subcellular resolution during ongoing colonoscopy and leads to highly selected mucosal biops…

Duodenal and rectal varices as a source of severe upper and lower gastrointestinal bleeding

A New Video Section of the Journal: Gastroenterology in Motion

TGF-β Suppresses Tumor Progression in Colon Cancer by Inhibition of IL-6 trans-Signaling

Alterations of TGF-beta signaling have been described in colorectal cancer, although the molecular consequences are largely unknown. By using transgenic mice overexpressing TGF-beta or a dominant-negative TGF-betaRII, we demonstrate that TGF-beta signaling in tumor infiltrating T lymphocytes controls the growth of dysplastic epithelial cells in experimental colorectal cancer, as determined by histology and a novel system for high-resolution chromoendoscopy. At the molecular level, TGF-beta signaling in T cells regulated STAT-3 activation in tumor cells via IL-6. IL-6 signaling required tumor cell-derived soluble IL-6R rather than membrane bound IL-6R and suppression of such TGF-beta-depende…

Colonoscopy for screening of colorectal cancer. What are the news? Review

The goal of every routine endoscopy in the gut is the early diagnosis of malignant and premalignant changes of the mucosa. Chromo- and magnifying endoscopes are exciting new tools and offer detailed analysis of the colonic mucosal surface and pit pattern architecture. This review summarizes recent advances in endoscopic characterization of colorectal lesions using magnification endoscopy and chromoendoscopy. Surface analysis of the colon using chromoendoscopy allows a prediction between nonneoplastic and neoplastic lesions with high specificity. The precise delineation of the borders and a more detailed macroscopic analysis of the lesions are further advantages. In particular, flat adenomas…

Analysis of interobserver variability for endomicroscopy of the gastrointestinal tract

a b s t r a c t Background: Endomicroscopy allows in vivo microscopic investigation of enteral mucosa during endo- scopic examinations. The aim of this study was to determine interobserver variability in the evaluation of endomicroscopic pictures of several organs by groups of investigators composed of confocal experts, pathologists and students. Methods: Twenty-five selected representative endomicroscopic pictures of the colon, stomach and oesophagus (total number, 75) were evaluated based on tissue, inflammatory and neoplastic changes (secondary endpoints). The endomicroscopic presence of neoplastic features was the primary endpoint and correlated with the final histological diagnosis. Re…

Chromoendoscopy: What Is Its True Value for Ulcerative Colitis Surveillance?

Advanced imaging technologies are enabling targeted biopsies or endoscopic resections due to better visualization of the mucosal architecture. This new concept of ‘smart biopsies’ is in particular important for patients with higher risk for development cancer (e.g. ulcerative colitis) but can also be beneficial for screening purposes. This short review will focus on new imaging modalities like chromoendoscopy, digital chromoendoscopy, high-definition endoscopy and confocal laser endomicroscopy in the lower GI tract which will be crucial in the future to detect colorectal neoplasia earlier then before.

Functional and Molecular Imaging with Confocal Laser Endomicroscopy

In vivo functional and molecular imaging is an emerging new field in gastroenterology. Ex vivo histopathological examination of tissue specimens offers a snapshot view into the tissue, capturing the moment at which the biopsy has been taken. The specimen is subjected to the fixation and staining process, making it prone to artefact. In vivo imaging with confocal endomicroscopy, however, offers the possibility of dynamic monitoring of the living tissue without the need for fixation. To our current knowledge, staining with intravenous fluorescein sodium or topical acriflavine hydrochloride does not alter tissue properties in a way that could influence biological processes. Therefore, with con…

Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison.

Background and study aims Endoscopic staining methods are increasingly being used to evaluate lesions in the esophagus and colon. The aim of this prospective study was to investigate chromoendoscopy and magnification endoscopy for the evaluation of mucosal lesions in the duodenum. Patients and methods Consecutive patients were randomly assigned to undergo conventional endoscopy without staining (group A) or intravital staining of the duodenal mucosa with indigo carmine and evaluation with a conventional video endoscope (group B) or a magnification endoscope (group C). Visible lesions were characterized before and after staining, and biopsies were taken for histological assessment. Results A…

In vivo confocal laser laparoscopy allows real time subsurface microscopy in animal models of liver disease.

Background/Aims Histopathology is essential in the diagnostic workup of most liver diseases. However, biopsy sampling might carry risks, is subject to sampling error, and does not provide dynamic tissue imaging. Therefore a newly developed miniaturised confocal probe was evaluated for in vivo microscopic imaging in rodent models of human liver diseases. Methods The handheld laparoscopy probe used a 488nm single line laser for fluorophore excitation. Optical slice thickness was 7μm, lateral resolution 0.7μm. Imaging depth was 0–250μm below the tissue surface. Imaging using different fluorescent staining protocols was performed in healthy mice, IFNγ- and IL-12-induced hepatitis, after bile du…

Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis.

Timely diagnosis of intraepithelial neoplasias (IN) and colitis-associated colon carcinomas (CRC) is crucially important for the treatment of ulcerative colitis (UC). We performed a randomized, controlled trial to test whether chromoendoscopy (CE) might facilitate early detection of IN and CRC in UC.A total of 263 patients with long-standing UC (or=8 years) were screened for potential inclusion in the study, 165 of whom were randomized at a 1:1 ratio to undergo conventional colonoscopy or colonoscopy with CE using 0.1% methylene blue. Five mucosal biopsy specimens were taken every 10 cm between the rectum and cecum. Circumscript lesions in the colon were evaluated according to a modified pi…

Détection du cancer colorectal et des lésions prémalignes par chromoscopie et endoscopie à optique grossissante

En Europe, le cancer colorectal (CCC) est la seconde cause de mortalite consecutive a une pathologie tumorale [1]. En depit des techniques chirurgicales eprouvees et des nouvelles formes de chimiotherapie, les tumeurs invasives, a l’exception des stades du debut, conservent encore a 5 ans des resultats de survie decevants, de l’ordre de 70 % avec envahissement metastatique proximal et seulement 6% en cas de metastase a distance [1]. Les taux de survie et de mortalite du CCR peuvent etre ameliores par une detection de cancer au debut a un stade preclinique. Par consequent, l’incidence du CCR peut etre reduite grâce a une detection endoscopique de lesions premalignes ou de cancers au debut. L…

Mini-laparoscopy in the endoscopy unit: Safety and outcomes in over one thousand patients

AIM: To investigate the safety of consecutive mini-laparoscopy guided liver biopsies for the diagnosis and staging of liver diseases. METHODS: In this study we retrospectively analyzed the safety of mini-laparoscopic liver biopsy performed in an endoscopy unit in 1071 patients. We measured the incidence of bleeding and evaluated the management and outcome of bleeding interventions. RESULTS: The most common etiologies of liver injury were viral hepatitis and autoimmune liver disease. 250 patients had macroscopically and histologically proven cirrhosis. 13 patients had no pathological findings. 33% of all patients had bleeding that required argon plasma coagulation of the puncture site during…

Chromoendoscopy: An Evolving Standard in Surveillance for Ulcerative Colitis

Advances in confocal laser endomicroscopy for the diagnosis of gastrointestinal diseases

Confocal laser endomicroscopy (CLE) is a novel technique enabling in vivo microscopy of the human gastrointestinal mucosa. Cellular details even below the tissue surface can be visualized at high resolution during ongoing endoscopy.This review summarizes the current clinical data on the use of CLE in different disease states and discusses a perspective for future clinical and scientific application of CLE.Review on published literature and meeting abstracts.Confocal laser endomicroscopy covers a growing field of indications in both upper and lower gastrointestinal endoscopy and beyond. It has been shown to reliably predict the presence of neoplastic lesions and inflammatory changes of the g…

Microarchitecture of the Normal Gut Seen with Conventional Histology and Endomicroscopy

For ex vivo histological examination of the gastrointestinal tract, fractions of an organ or small pieces of tissue are needed. Several steps are used in the fixation, staining, and mounting process to ensure production of good-quality histology on glass slides. The most frequently used stain in routine histology is the haematoxylin and eosin (H&E) stain. The most frequently used tissue-staining methods are shown in ⊡ Table 6.1. The final histopathological diagnosis is always based on examination of the whole sample and the structure and architecture of that sample. In cytology, single cells and nuclei are used for making a diagnosis, so staining procedures in cytology are much faster and e…

Mini-laparoscopy in the endoscopy unit.

PURPOSE OF REVIEW: The evaluation of liver histology is an important component of the diagnosis and staging of liver diseases. The most common technique employed to sample liver tissue for decades has been percutaneous liver biopsy. Although this is a relatively well tolerated technique in the early stages of liver disease, it carries a high risk of complications, particularly hemorrhage, in patients with advanced cirrhosis. Mini-laparoscopy allows macroscopic assessment and biopsy under direct vision and therefore is a well tolerated and effective technique. RECENT FINDINGS: The major advantages of this technique are direct visualization of the liver surface, thereby allowing inspection fo…

Confocal laser endoscopy: new approach to the early diagnosis of tumors of the esophagus and stomach

The prognosis of malignancies of the upper gastrointestinal tract is poor if early diagnosis is missed. Therefore, a rapid in vivo diagnosis of early cancer and premalignant lesions is highly important for succesful therapy. Confocal laser endomicroscopy allows in vivo cellular and subcellular imaging at high resolutions during ongoing endoscopy. The first studies and clinical observations suggest a major role of this novel technique in the in vivo diagnosis of cancer of the esophagus and stomach and of precursor conditions, such as Barrett’s esophagus, intestinal metaplasia of the stomach and Helicobacter pylori infection. Based on recent experiences from animal models, future studies wil…

Confocal laser endomicroscopy for gastrointestinal diseases.

Confocal laser endomicroscopy enables in vivo microscopy of the mucosal layer of the gastrointestinal tract with subcellular resolution during ongoing endoscopy. Endomicroscopy opens the door to immediate tissue and vessel analysis. Different types of diseases can be diagnosed with optical surface and subsurface analysis. Analysis of the in vivo microarchitecture can be used for targeting biopsies to relevant areas, and subsurface imaging can unmask microscopic diseases or bacterial infection. Molecular imaging is becoming feasible, which will enable new indications in gastrointestinal endoscopy. This article reviews the current and rapidly expanding clinical data on endomicroscopy and give…

Chromoendoscopy and narrow-band imaging compared with high-resolution magnification endoscopy in Barrett's esophagus.

Background & Aims: The aim of this study was to compare magnified still images obtained with high-resolution white light endoscopy, indigo carmine chromoendoscopy, acetic acid chromoendoscopy, and narrow-band imaging to determine the best technique for use in Barrett's esophagus. Methods: We obtained magnified images from 22 areas with the 4 aforementioned techniques. Seven endoscopists with no specific expertise in Barretes esophagus or advanced imaging techniques and 5 international experts in this field evaluated these 22 areas for overall image quality, mucosal image quality, and vascular image quality. In addition, the regularity of mucosal and vascular patterns and the presence of abn…

High definition plus colonoscopy combined with i-scan tone enhancement vs. high definition colonoscopy for colorectal neoplasia: A randomized trial

High definition endoscopy is the accepted standard in colonoscopy. However, an important problem is missed polyps.Our objective was to assess the additional adenoma detection rate between high definition colonoscopy with tone enhancement (digital chromoendoscopy) vs. white light high definition colonoscopy.In this prospective randomized trial patients were included to undergo a tandem colonoscopy. The first exam was a white light colonoscopy with removal of all visualized polyps. The second examination was randomly assigned in a 1:1 ratio as either again white light colonoscopy (Group A) or colonoscopy with tone enhancement (Group B). Primary endpoint was the adenoma detection rate during t…

Evolving endoscopic strategies for detection and treatment of neoplastic lesions in inflammatory bowel disease

The paradigm for neoplasia surveillance in IBD is rapidly evolving with advancements in endoscopic imaging technology. Modern technology has demonstrated a remarkably improved capacity to detect and characterize subtle neoplastic lesions. As such, practices of obtaining interval random biopsy specimens to identify “invisible”neoplasia and of recommending total proctocolectomy for treatment of early neoplastic lesions are gradually being phased out. Further research is required to confirm the safety and effectiveness of endoscopic resection of more advanced neoplastic lesions, including DALMs and lesions bearing HG-IEN. Moving forward, studies evaluating CRC risk profiles in IBD patients wou…

Supportive evidence for FOXP 1 , BARX 1 , and FOXF 1 as genetic risk loci for the development of esophageal adenocarcinoma

The Barrett's and Esophageal Adenocarcinoma Consortium (BEACON) recently performed a genome-wide association study (GWAS) on esophageal adenocarcinoma (EAC) and Barrett's esophagus. They identified genome-wide significant association for variants at three genes, namely CRTC1, FOXP1, and BARX1. Furthermore, they replicated an association at the FOXF1 gene that has been previously found in a GWAS on Barrett's esophagus. We aimed at further replicating the association at these and other loci that showed suggestive association with P < 10(-4) in the BEACON sample. In total, we tested 88 SNPs in an independent sample consisting of 1065 EAC cases and 1019 controls of German descent. We could repl…

Chromoendoscopy and Other Novel Imaging Techniques

The newly developed high-resolution and magnification endoscopes offer features that allow more and new mucosal details to be seen. They are commonly used in conjunction with chromoendoscopy. The analysis of mucosal surface details is beginning to resemble histologic examination. More accurate recognition of small flat and depressed neoplastic lesions is possible. Endoscopic prediction of neoplastic and nonneoplastic tissue is possible by analysis of surface architecture of the mucosa, which influences the endoscopic management. For the diagnosis of flat adenomas, chromoendoscopy should be a part of the endoscopist's armamentarium. In inflammatory bowel disease, chromoendoscopy can be used …

Acetic acid-guided biopsies after magnifying endoscopy compared with random biopsies in the detection of Barrett's esophagus: a prospective randomized trial with crossover design.

Background In contrast to standard video endoscopy, magnifying endoscopy after local acetic acid application enables recognition of mucosal surface architecture. Objective To investigate the diagnostic yield of magnifying endoscopy with acetic acid–targeted biopsies compared to random, 4-quadrant biopsies. Design Prospective randomized trial (ratio 1:1) with crossover design. Setting Two referral hospitals in Germany. Patients Thirty-one patients with Barrett's esophagus or visible columnar-lined lower esophagus. Interventions Patients were randomized to undergo either standard video endoscopy with 4-quadrant biopsies or magnifying endoscopy in conjunction with acetic acid application. All …

1136 In Vivo Endoscope-Based Confocal Laser Endomicroscopy (eCLE) Improves Detection of Unlocalized Barrett's Esophagus-Related Neoplasia Over High Resolution White Light Endoscopy: an International Multicenter Randomized Controlled Trial

Drug insight: novel small molecules and drugs for immunosuppression.

Gastrointestinal diseases can result from the inadequate or excessive response of the immune system to self or innocuous antigens. Moreover, the physiologic activation of the immune system against non-self antigens is a major clinical problem in liver organ transplantation. At present, many drugs are available that suppress the activation of the immune system, although most of the currently used immunosuppressive drugs lack specificity in terms of their molecular targets and, therefore, have the potential to generate numerous side effects. The advances that have been made in understanding the molecular events that underlie the activation of the immune system have led to the development of a…

Kombiniertes Simulationstraining: Ein neues Kurskonzept trainiert und verbessert das Krisenmanagement der gastroenterologischen Endoskopie

Introduction Crisis management as well as realistic emergency situations can be trained in the new developed simulation workshop "Gastrointestinal Endoscopy and Crisis Resource Management" by combining a full-scale simulator and the Erlanger Endoscopy Trainer. The aim of the current study was to evaluate the efficiency of the newly developed simulation workshop. Methods Endoscopists with more than 12 months experience can train their endoscopic skills and crisis resource management with the help of different simulators. In addition, two different scenarios (GI bleeding with significant blood loss and sedation overdoses) embedded in a realistic surrounding (emergency room) have to be managed…

What new endoscopic imaging modalities will become important in the diagnosis of IBD?

Collagenous colitis: new diagnostic possibilities with endomicroscopy

Collagenous colitis is a kind of microscopic colitis. It is characterized by chronic watery diarrhea and abdominal pain. The etiology is still unknown. So far, for the diagnose a histological evaluation was necessary with the presence of thickened subepithelial collagneous bands in the lamina propria. A new developed endoscope with a confocal laser allows analysing cellular and subcellular details of the mucosal layer at high resolution in vivo. In this case report we describe for the first time to diagnose collagenous colitis during ongoing colonoscopy by using this confocal endomicroscopy. In a 67 year old female patient with typical symptoms the characteristic histological changes could …

Tu1451 Medjet - A New CO2 Based Disposable Cleaning Device Allows Safe and Effective Colon Cleansing During Colonoscopy: A Prospective Open Labeled Controlled Trial

Ulcerative colitis - How can we improve surveillance colonoscopy?

In vivo imaging of colitis and colon cancer development in mice using high resolution chromoendoscopy

Background: Mouse models of colitis and cancer are indispensable for our understanding of the pathogenesis of these diseases. In the past, mice had to be sacrificed in order to analyse colitis activity and tumour development. We have developed a safe method for high resolution endoscopic monitoring of living mice. Methods: Mice developing colitis or colonic tumours were anaesthetised using avertine and repeatedly examined by endoscopy. A novel miniendoscope (1.9 mm outer diameter), denoted Coloview, was introduced via the anus and the colon was carefully insufflated with an air pump before analysis of the colonic mucosa. An extra working channel allowed the introduction of biopsy forceps or…

Mini-Laparoscopically Guided Percutaneous Gastrostomy and Jejunostomy

Abstract Background: Percutaneous endoscopic tube placement can be problematic under certain circumstances: absence of transillumination of the abdominal wall, percutaneous jejunostomy in patients with a PEG tube and recurrent aspiration, enteral feeding access after gastrectomy, and obstruction of the upper GI tract. As an alternative in these problematic situations, a technique was developed for placing feeding tubes under visual control by using mini-laparoscopy. Methods: Placement of a feeding tube with mini-laparoscopy with the patient under conscious sedation was considered for 17 patients in whom standard PEG placement was impossible. Techniques used were the following: combined mini…

In Vivo Molecular Imaging of Somatostatin Receptors in Pancreatic Islet Cells and Neuroendocrine Tumors by Miniaturized Confocal Laser-Scanning Fluorescence Microscopy

The aim of the study was to evaluate real time in vivo molecular imaging of somatostatin receptors (sstrs) using a handheld miniaturized confocal laser scan microscope (CLM) in conjunction with fluorescein-labeled octreotate (OcF) in healthy mice and murine models of neuroendocrine tumors. For CLM a small rigid probe (diameter 7 mm) with an integrated single line laser (488 nm) was used (optical slice thickness 7 μm; lateral resolution 0.7 μm). OcF was synthesized via Fmoc solid-phase peptide synthesis and purified by HPLC showing high-affinity binding to the sstr2 (IC50 6.2 nmol). For in vitro evaluation, rat and human pancreatic cancer cells were used and characterized with respect to its…

Perspectives of Chromo and Magnifying Endoscopy

The goal of every routine endoscopy in the gut is the early diagnosis of malignant and premalignant changes of the mucosa. Chromo- and magnifying endoscopes are exciting new tools and offer detailed analysis of the colonic mucosal surface and pit pattern architecture. This review summarizes recent advances in endoscopic characterization of colorectal lesions using magnification endoscopy and chromoendoscopy. Surface analysis of the colon using chromoendoscopy allows a prediction between non-neoplastic and neoplastic lesions with high specificity. The precise delineation of the borders and a more detailed macroscopic analysis of the lesions are further advantages. In particular, flat adenoma…

Value of magnification- and chromo-endoscopy compared with video-endoscopy

Simultaneous confocal laser endomicroscopy and chromoendoscopy with topical cresyl violet

Background Confocal laser endomicroscopy (CLE) has been shown to reliably predict histology during ongoing endoscopy. To unmask lesions for CLE, chromoendoscopy has been mandated. Usually fluorescein then serves as a contrast agent for CLE, but it does not allow direct nuclear visualization, must be injected, leads to a transient skin discoloration, and may have allergic side effects. Objective To establish a single topical dye, cresyl violet (CV), for simultaneous chromoendoscopy and in vivo CLE of the lower GI tract. Design Animal preclinical study, prospective clinical trial. Setting Mainz University Clinic (tertiary care center). Patients, Methods, and Interventions To establish the sta…

Endomicroscopy is born—do we still need the pathologist?

Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo

Background & Aims: Aconfocal laser endoscopy system has recently been developed that may allow subsurface imaging of living cells in colonic tissue in vivo. The aim of the present study was to assess its potential for prediction of histology during screening colonoscopy for colorectal cancer. Methods: Twenty-seven patients underwent colonoscopy with the confocal endoscope using acriflavine hydrochloride or fluorescein sodium with blue laser illumination. Furthermore, 42 patients underwent colonoscopy with this system using fluorescein sodium. Standardized locations and circumscript lesions were examined by confocal imaging before taking biopsy specimens. Confocal images were graded accordin…

In vivo molecular imaging of gastric cancer by targeting MG7 antigen with confocal laser endomicroscopy.

Background and study aims: In vivo molecular imaging represents a powerful tool for the immediate diagnosis of gastric cancer. In this study, the monoclonal antibody MG7, which is a specific molecular marker against gastric cancer, was labeled with fluorescent agents to enable in vivo real-time imaging by confocal laser endomicroscopy (CLE). Patients and methods: In vivo molecular imaging was performed in tumor-bearing mice from two kinds of human gastric cancer cell lines. Xenograft tumors were visualized in vivo first with a whole-body fluorescent imaging device and then by CLE using fluorescently labeled MG7 antibody. Gastric cancerous tissue and noncancerous mucosa from human biopsies o…

High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial.

Introduction Colonoscopy is the accepted gold standard for the detection of colorectal cancer. The aim of the current study was to prospectively compare high definition plus (HD+) colonoscopy with I-Scan functionality (electronic staining) vs. standard video colonoscopy. The primary endpoint was the detection of patients having colon cancer or at least one adenoma. Methods A total of 220 patients due to undergo screening colonoscopy, postpolypectomy surveillance or with a positive occult blood test were randomized in a 1 : 1 ratio to undergo HD+ colonoscopy in conjunction with I-Scan surface enhancement (90i series, Pentax, Tokyo, Japan) or standard video colonoscopy (EC-3870FZK, Pentax). D…

Frequency and Characterization of Benign Lesions in Patients Undergoing Surgery for the Suspicion of Solid Pancreatic Neoplasm

A diagnosis of benign lesions (BLs) is reported in 5% to 21% of pancreatoduodenectomies performed for neoplasms; no data for body-tail resections are available. The aims were to investigate the frequency and characterize the BLs mimicking cancer in the head and the body-tail of the pancreas.This study is a retrospective review of pancreatic specimenscollected from 2005 to 2011 in the pathology database of Mainz (Germany). Patients with final diagnosis excluding malignancy were analyzed by histology, imaging, and clinical aspects.Among 373 patients, 33 patients (8.8%) were diagnosed with a benign disease: 25 (8.4%) of 298 in the pancreatic head and 8 (10.7%) of 75 in the body-tail resections…

Mo2021 Predicting Polyp Histology - Development and Validation of an International Simple Endoscopic Classification of Small Colorectal Polyps Using the Novel I-Scan Optical Enhancement Colonoscope

Confocal laser endomicroscopy is a new imaging modality for recognition of intramucosal bacteria in inflammatory bowel disease in vivo.

International audience; BACKGROUND AND OBJECTIVES: Interaction of bacteria with the immune system within the intestinal mucosa plays a key role in the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to develop a fluorescein-aided confocal laser endomicroscopy (CLE) method to visualise intramucosal enteric bacteria in vivo and to determine the involved mucosal area in the colon and ileum in patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Initially, E coli strains expressing enhanced green fluorescent protein (pEGFP) were endomicroscopically imaged in mice. In addition, ex vivo and in vivo imaging of fluorescent human enteric bacteri…

Massive gastrointestinale Blutung eines 28-jährigen Patienten mit intestinalem Befall eines Morbus Behçet

A 28-year-old man was admitted to the emergency room of our hospital after syncope and acute gastrointestinal bleeding. On the basis of numerous oral and genital ulcerations as well as uveitis anterior and erythema nodosum, the diagnosis of Behcet's disease had been confirmed previously. The bleeding focus could not be detected by endoscopy. During the next days recurrent massive hemorrhages occurred in spite of immunosuppressive therapy with steroids. Angiography revealed a circumscribed bleeding source in the colon transversum near the left colonic flexure, which was treated by superselective coil embolization. A massive hemorrhage reoccurred and required a surgical approach with a Hartma…

Confocal Laser Endomicroscopy: Technical Advances and Clinical Applications

Since its introduction in 2004, confocal laser endomicroscopy (CLE) has emerged as a valuable tool for gastrointestinal endoscopic imaging. Endomicroscopy enables the endoscopist to obtain real time in vivo histology during ongoing endoscopy thereby creating “optical biopsies.” To date, numerous studies have shown potential applications of endomicroscopy in the clinical setting, including in vivo diagnosis of esophageal squamous cell carcinoma, Barrett’s esophagus, celiac disease, and colonic polyps. Moreover, recent data suggest the potential application of endomicroscopy in the field of molecular imaging. Additionally, in recent months new applications and developments in the field of con…

Activation pattern of signal transducers and activators of transcription (STAT) factors in inflammatory bowel diseases.

Cytokine signaling pathways involving transcription factors of the signal transducers and activators of transcription (STAT) family play a key role in the pathogenesis of inflammatory bowel diseases (IBD). STAT proteins are latent cytoplasmic transcription factors that induce transcription upon phosphorylation, dimerization, and nuclear translocation. However, their activation pattern in IBD is poorly understood. The aim of our study was to characterize STAT-expression in IBD.Mononuclear cells were isolated from 36 colonic specimens of Crohn's disease, ulcerative colitis, or from control patients. Cells were stimulated overnight with antibodies against human CD2 and CD28 and mononuclear cel…

Recognition and characterization of small colonic neoplasia with high-definition colonoscopy using i-Scan is as precise as chromoendoscopy

Abstract Background The EPKi system (Pentax, Japan) enables resolution above HDTV. Aim of the study was to test the efficacy of HD+ alone and with the new post-processing digital filter i-Scan or chromoendoscopy (Methylene blue 0.1%) in screening for colorectal cancer. We focused on lesions less than 5 mm as a surrogate marker for the optical possibilities of the EPKi system. Methods The last 30 cm of the colon in a screening population were inspected with HD+ alone, in combination with i-Scan (2:1 randomisation) and subsequently with chromoendoscopy. All lesions were characterized and targeted biopsies were performed. Results i-Scan augmented in 69 patients the identification of lesions fr…

Molecular in vivo imaging of gastric cancer in a human-murine xenograft model: targeting epidermal growth factor receptor

Background The prognosis of gastric cancer depends on early diagnosis. Targeted therapies against epidermal growth factor receptors (EGFRs) are currently emerging for the treatment of gastric cancer. Objective To specifically visualize gastric cancer by using monoclonal antibodies targeting EGFR1 as molecular probes for in vivo molecular confocal laser endomicroscopy (mCLE) in a human-murine xenograft model. Design Prospective in vivo animal study. Setting Animal laboratory. Interventions Human gastric carcinoma xenografts were examined in 26 nude mice by using mCLE after injection of fluorescently labeled antibodies. Nine mice received low-dose anti-EGFR1 antibodies, 7 mice cetuximab, and …

Su1645 G-Eyeâ,,¢ High-Definition Colonoscopy Increases Adenoma Detection Rate - a Prospective Randomized Multicenter Study of 1000 Patients

A 9-Year Retained T-Tube Fragment Encased within a Stone as a Rare Cause of Jaundice

Biliary diseases such as cholangitis may cause jaundice and liver damage. Here, we report on an unusual cause of jaundice in an 84-year-old man 9 years after cholecystectomy. Ultrasound analysis revealed unclear extrahepatic cholestasis and subsequent ERCP showed a large biliary stone sourrounding a T-tube fragment that had remained in the common bile duct for more than 9 years after surgery. The tip of the drainage and the stone could be successfully removed using Dormia baskets. This case suggests that plastic material accidentally left in the common bile duct favours the development of large biliary casts when present over long periods of time.

Revue : Possibilités des nouvelles techniques endoscopiques : coloration vitale et endomicroscopie confocalein vivo dans la détection des lésions précancéreuses et du cancer précoce chez les patients porteurs de colite ulcéreuse

L’enjeu de la surveillance endoscopique des patients souffrant de colite ulcereuse de longue duree est le diagnostic precoce des lesions malignes et des modifications precancereuses de la muqueuse.

Magnifying chromoendoscopy for the detection of premalignant gastrointestinal lesions

The prognosis for patients with malignancies of the gastrointestinal tract is strictly dependent on the early detection of premalignant and malignant lesions. At present, endoscopy can be performed with new, powerful high-resolution or magnifying endoscopes. Comparable to the rapid development in chip technology, the optic features of the newly designed endoscopes offer resolutions that allow new mucosal surface details to be seen. In conjunction with chromoendoscopy, the newly discovered tool of video endoscopy is much easier to use and more impressive than previously used fibreoptic endoscopy. This review summarises the value of magnifying endoscopy in the upper and lower gastrointestinal…

Chromoendoscopy and intravital staining techniques.

Chromoendoscopy and intravital staining techniques are synonymous methods for the endoscopic early detection of malignant changes in the intestinal tract. Endoscopic intravital staining involves the use of absorptive stains (methylene blue and Lugol's solution), contrast stains (indigo carmine) and reactive stains (Congo red). Lugol's iodine solution is used to identify superficial carcinomas in the squamous epithelium of the oesophagus. Methylene blue stains the specialized intestinal epithelium in Barrett's oesophagus and, in addition to this, is helpful in the diagnosis of dysplasia. Intravital staining with indigo carmine contributes to contrasting and accentuating changed mucosal proce…

Advanced imaging of the gastrointestinal tract: research vs. clinical tools?

Diagnostic endoscopy has moved forward considerably in the recent years. Still, three major needs have to be satisfied: endoscopy should be able to detect a lesion, characterize the lesion, and then its nature should be confirmed. These steps should ideally translate into an immediate therapeutic decision.High definition endoscopy has optimized our endoscopic view onto the mucosa and can be combined with digital surface enhancement modalities. Chromoendoscopy still holds a place to detect especially flat lesions in high-risk patients such as ulcerative colitis. Digital chromoendoscopy techniques such as narrow band imaging, i-scan, or Fuji intelligent chromo endoscopy offer new possibilitie…

284 Hemospray for Non-Variceal Upper Gastrointestinal Bleeding: Results of the Seal Dataset (Survey to Evaluate the Application of Hemospray in the Luminal Tract)

In vivo subsurface morphological and functional cellular and subcellular imaging of the gastrointestinal tract with confocal mini-microscopy.

AIM: To evaluate a newly developed hand-held confocal probe for in vivo microscopic imaging of the complete gastrointestinal tract in rodents. METHODS: A novel rigid confocal probe (diameter 7 mm) was designed with optical features similar to the flexible endomicroscopy system for use in humans using a 488 nm single line laser for fluorophore excitation. Light emission was detected at 505 to 750 nm. The field of view was 475 μm × 475 μm. Optical slice thickness was 7 μm with a lateral resolution of 0.7 μm. Subsurface serial images at different depths (surface to 250 μm) were generated in real time at 1024 × 1024 pixels (0.8 frames/s) by placing the probe onto the tissue in gentle, stable co…

Confocal laser endomicroscopy for the diagnosis of urothelial bladder neoplasia: a technology of the future?

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Bladder cancer is initially diagnosed by white light cystoscopy followed by histopathological evaluation after transurethral resection of tissue suspicious for cancer. Difficulties may occur especially in the assessment of flat lesions or in discrimination between CIS and inflammatory disease. Confocal endomicroscopy during diagnostic colonoscopy has been a valuable tool for in vivo microscopic visualization and detection of colonic neoplasias and has contributed to optimized detection rates of up to 99%. We evaluated resected bladder urothelium of 18 patients by confo…

S3-Leitlinie „Magenkarzinom” -

Advances in endoscopic imaging of colorectal neoplasia.

Colon cancer screening is arguably the most important activity performed by gastroenterologists. Recent decreases in rates of death from colorectal cancer indicate that screening methods such as colonoscopy have a positive impact. There is still room for improvement, however, particularly in prevention of right-sided colon cancer. Practice issues, such as making colonoscopy more comfortable, safer, and less costly, are keys to continued success in cancer prevention. Colonoscopy techniques, technologies, and quality control measures have advanced to improve detection, classification, and removal of early neoplasias. In particular, slow, careful inspection of the colon by gastroenterologists …

Endomicroscopy of Small Bowel Diseases: Coeliac Disease, Lymphoma

The different components making up the complement of immune elements within the alimentary tract vary greatly. In contrast to the Waldeyer’s ring region, the oesophagus and stomach are normally almost devoid of such immune apparatus, presumably because of the rapid transit of food and the chemically hostile environment for micro-organisms provided by salivary and gastric secretions. Only in pathological conditions, such as viral or fungal oesophageal infections, reflux oesophagitis or Helicobacter gastritis, does one encounter acquired mucosa-associated lymphoid tissue in these sites [1]. By contrast, the large and small bowel normally possess mucosa-associated lymphoid tissue (MALT), most …

1101 Molecular In-Vivo Imaging of Gastrointestinal Neoplasia With Endomicroscopy Using Therapeutic Antibodies Against EGFR

Recurrent gastrointestinal haemorrhage from the distal duodenum

In October 2004, a 69 year female patient presented with melena and anaemia (haemoglobin level 9 g/dl). The patient had been on warfarin due to construction of an aorto-bifemoral graft because of an aortic aneurysm and an …

Technology Insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer

Recent studies on a novel technology, denoted confocal laser endomicroscopy (CLE), have altered thinking about the possibilities of endoscopy in the diagnosis and treatment of colorectal cancer. CLE is a new endoscopic tool that allows in vivo histology at subcellular resolution during ongoing endoscopy, and permits subsurface imaging of normal and neoplastic human mucosa. This new technique has unequivocal major implications for the diagnosis and clinical management of patients scheduled for screening or surveillance colonoscopy for colorectal cancer. For instance, CLE allows immediate diagnosis of colonic neoplasias, and the detection of neoplastic cells helps to target endoscopic interve…

Confocal microscopy: is there a future in view of current results?

In vivo histology of Barrett's esophagus and associated neoplasia by confocal laser endomicroscopy.

Background & Aims: Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy. Here, we have applied this technique to the in vivo diagnosis of Barrett's epithelium and associated neoplasia. Methods: Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus. Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed. In vivo histology was compared with the histologic specimens. All digitally stored images were re-assessed by a b…

Chromo- and magnifying endoscopy for colorectal lesions

It is essential to identify patients with premalignant or early malignant changes during colonoscopy. Thus, curative resection can be offered. At present, endoscopy can be performed with new powerful high-resolution or magnifying endoscopes. Comparably to the rapid development in chip technology, the optic features of the newly designed endoscopes offer resolutions which allow new mucosal surface details to be seen. In conjunction with chromoendoscopy, the newly discovered tool video endoscopy is much easier and more impressive than with conventional fibre optics. This review summarizes the value of magnifying endoscopy in the lower gastrointestinal tract and focuses on colorectal lesions.

Colonoscopy, Tumors, and Inflammatory Bowel Disease - New Diagnostic Methods

Accurate detection of premalignant lesions and early cancers in the colon is essential for curative endoscopic or surgical therapy, since the prognosis for the affected patients is closely related to the size and stage of the neoplastic lesion. Total colonoscopy is the accepted gold standard for screening and surveillance of colorectal cancer. This review summarizes recently published diagnostic developments and key findings in the areas of colonoscopy, colonic tumors, and inflammatory bowel diseases. Relevant findings have been reported for chromo-endoscopy in the diagnosis of colitis-associated neoplasia, as well as flat and depressed adenomas. Real-time Doppler capabilities have now been…

Frequency and Characterization of Benign Lesions in Pancreatic Specimens of Patients Operated for the Suspicion of Pancreatic Cancer

Context A final diagnosis of benign lesions is reported in up to 21% of patients who underwent duodenocephalopancreatectomy for neoplasia, whereas no data have yet been published for resection of the body-tail. Objective To investigate the frequency and to characterize the benign lesions mimicking a neoplasia in the head and in the body-tail of the pancreas. Methods We retrospectively reviewed all the pancreatic specimens collected from 2005 to 2011 in the database of the Institute of Pathology of Mainz. Patients with a final diagnosis excluding malignancy were analyzed by histological, clinical and imaging findings. Results Three-hundreds and 73 patients were identified. A final diagnosis …

Improved Sedation in Diagnostic and Therapeutic ERCP: Propofol is an Alternative to Midazolam

Background and Study Aims: Adequate sedation of the patient is required for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The anesthetic propofol, with its shorter half-life, affording better control, offers an alternative to the benzodiazepine midazolam. The aim of this randomized, controlled, unblinded study was to compare prospectively the quality of sedation under propofol and midazolam in patients undergoing ERCP. Patients and Methods: A total of 80 patients were randomized to sedation with propofol alone (n=40) or midazolam alone (n = 40). Blood pressure, pulse, and oxygen saturation were measured. Midazolam was given by the endoscopist and titrated…

Minimal Change Esophagitis: Prospective Comparison of Endoscopic and Histological Markers between Patients with Non-Erosive Reflux Disease and Normal Controls Using Magnifying Endoscopy

&lt;i&gt;Introduction:&lt;/i&gt; More than half the patients with gastroesophageal reflux disease (GERD) show no endoscopic abnormality or minimal change esophagitis (non-erosive reflux disease, NERD). We investigated the value of endoscopic and histological markers for the prediction of NERD before and after treatment with 20 mg esomeprazole. &lt;i&gt;Methods:&lt;/i&gt; Between July and October 2002, consecutive patients presenting for upper endoscopy were stratified into GERD and non-reflux patients (control group) with the help of a questionnaire. The endoscopist was blind to the presence of reflux symptoms. Using magnifying endoscopes minimal change esophagitis was defined by the presen…

Enhanced Endoscopy in Inflammatory Bowel Disease

Enhanced imaging technologies are of special importance in patients with inflammatory bowel diseases. Patients with long-lasting colitis face an increased cancer risk and neoplastic changes often evolve as subtle, multifocal, and flat lesions. Enhanced endoscopic imaging technologies enable better visualization of the mucosal architecture. These new available information can be used to better detect and characterize colorectal lesions. The better endoscopic judgment leads to more targeted biopsies and cancer detection can be facilitated. This new concept of “smart biopsies” is in particular important for screening purposes. Furthermore, the technique of endomicroscopy enables in vivo histol…

Confocal laser endomicroscopy: technical status and current indications.

Confocal laser endomicroscopy is a newly introduced endoscopic tool that makes it possible to carry out confocal microscopic examination of the mucosal layer during ongoing endoscopy. Different types of tissue and diseases can be diagnosed immediately, facilitating early diagnosis of gastrointestinal cancer. Analysis of the in vivo microarchitecture is helpful in targeting biopsies to relevant areas. In addition, subsurface imaging can unmask microscopic diseases - (microscopic colitis) or bacterial infection ( HELICOBACTER PYLORI), for example. Molecular imaging is becoming feasible, and this will shortly open the door to new indications in gastrointestinal endoscopy (e.g., in vivo recepto…

Endomicroscopy for in vivo Diagnosis of Colorectal Cancer

In-vivo confocal real-time mini-microscopy in animal models of human inflammatory and neoplastic diseases

Background and study aims Although various improvements in tissue imaging modalities have recently been achieved, in-vivo molecular and subsurface imaging in the field of gastroenterology remains a technical challenge. In this study we evaluated a newly developed, handheld, miniaturized confocal laser microscopy probe for real-time in-vivo molecular and subsurface imaging in rodent models of human disease. Materials and methods The minimicroscope uses a 488-nm, single line laser for fluorophore excitation. The optical slice thickness is 7 microm, the lateral resolution 0.7 microm. The range of the z-axis is 0-250 microm below the tissue surface. Imaging was performed using different fluores…

Tu1656 Endomicroscopy of Intramuscular Neuronal Network Using Confocal Laser Endomicroscopy: A New Diagnostic Approach for Enteral Motility Disorders

Endomicroscopy of Colon Pathology

Colorectal cancer is still one of the leading causes of cancer-related death in the Western world. Screening colonoscopy is widely accepted as the gold standard for early diagnosis of cancer. The prognosis for patients with colonic neoplasms is strictly dependent on the depth of infiltration and therefore depends on early detection of pre-invasive and neoplastic changes. Early detection makes it possible to cure the patient by means of immediate endoscopic resection.