Imaging and Advanced TechnologyConfocal Laser Endomicroscopy: Technical Advances and Clinical Applications
Section snippets
Technical Advances
CLE is based on tissue illumination with a low-power laser. The laser light is reflected from the tissue and refocused onto the detection system by the same lens, meaning that only returning light refocused through the pinhole is detected. Therefore, CLE provides high-resolution images, enabling optical biopsies and in vivo histology.
To obtain confocal images, exogenous fluorescence agents have to be applied, which can either be administered systemically or topically. The most widely used
Clinical Applications
To date, numerous studies have addressed the clinical applications and value of CLE in different settings. For instance, 5 prospective studies evaluated the clinical use of CLE in diagnosing Barrett's esophagus and associated neoplasia. Endomicroscopy could distinguish between different types of metaplasia and cell types and was able to detect intraepithelial neoplasia and cancer based on distinct cell characteristics with high accuracy (88–97%) and interobserver agreement (0.6–0.8).
Molecular Imaging
Considerable efforts have been made to perform molecular imaging studies using endomicroscopy. Molecular imaging means the fluorescent labeling of individual cells by their molecular signature in vivo. Therefore, molecular imaging enables visualization of disease-specific morphologic or functional tissue alterations and has thus the potential to provide individualized, molecularly targeted therapies.
To develop a probe for detecting colon cancer, a phage library was screened and a specific
Conclusion
Endomicroscopy allows real-time in vivo histologic diagnosis of the mucosal layer of the gastrointestinal tract at cellular and subcellular resolution during ongoing endoscopy with high accuracy and is comparable to histopathological examination. Currently, 2 FDA-approved devices for endomicroscopy are available. One device is integrated into the distal tip of a high-resolution endoscope, and one represents a stand-alone confocal miniprobe that is capable of passage through the accessory
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Conflicts of interest The authors disclose the following: Dr Ralf Kiesslich has an unrestricted grant, is a consultation and speaker for Pentax Europe. Dr Markus Neurath received a research grant, speaker's fees, and is a consultant for Pentax. Dr Michael B. Wallace receives research funding from Olympus, Mauna Kea, and Fujinon and is a consultant to Olympus for issues unrelated to imaging technology. Dr Helmut Neumann discloses no conflicts.