A discipline looking for innovation

Over the past 20 years, innovations in technology have dramatically changed the field of gastrointestinal endoscopy. The evolution from fiberoptic to video-endoscopy has both improved image resolution and provided a new viewing format, thus modifying the daily practice of endoscopy. A variety of endoscope models and manufacturers exist. Procedure-specific endoscopes have been designed to enhance endoscopic diagnosis and therapy. Endoscopes have even radically changed format with the invention of capsule endoscopy.

Recently, chromoendoscopy has become popular as a diagnostic enhancement tool in endoscopy, expressing the remaining need for an even higher image definition leading to better tissue characterization.

But what is the ultimate goal of the endoscopist? To make an informed decision during the diagnostic endoscopy procedure and treat the lesion appropriately with the smallest number of physical biopsies. Chromoendoscopy provides a surface diffuse imaging. To target biopsies and improve patient care, the physician requires cellular structure visualization, meaning microscopic imaging.

And how to better achieve this goal than by miniaturizing the microscope to the level of an endoscopic accessory?

The closest step towards cellular visualization is confocal laser endoscopy using confocal miniprobes. This way, the physician can use the miniprobes as a biopsy forceps - a gesture he has performed day in and day out - and visualize tissue micro-structure with a definition never achieved before.

Courtesy of Dr. Ken Wang, Mayo Clinic, Rochester, MN, USA. Note that the scale bar is 50 microns !