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The confocal endoscope can be handled similarly to a
standard endoscope. Initially white-light endoscopy is used to identify
suspected lesions. Chromoendoscopy can be used in addition to unmask flat or
diminutive lesions. However, chromoendoscopy neither interferes with the
endomicroscopic system nor is it a prerequisite for confocal imaging.
After the application of the above mentioned contrast dyes endomicroscopy
becomes possible. A stable endoscope position is important to reduce
movement artifacts. Thus, the distal tip of the endoscope is placed in
gentle contact with the mucosa or lesion to obtain a stable position.
Endomicroscopy should always be used in a targeted fashion.
Panendomicroscopy (endomicroscopy of the whole gut surface and subsurface)
would be time consuming and ineffective.
The position of the focal plane within the specimen are adjusted using the
buttons on the endoscope control body. In every area of interest images from
the surface to deeper parts of the mucosal layer can be obtained and stored
digitally in a specific folder associated with the site of collection. In
vivo-histology becomes visible and an online diagnosis can be achieved. In
addition, the digitally stored images can be re-inspected during the ongoing
procedure or the images can be used later on for re-assessment or
comparative studies.
Endomicroscopic diagnosis is only possible with a fundamental knowledge of
the microarchitecture of the gut. Thus, the endoscopist is challenged with
new microscopic details that require pathology training and an
interdisciplinary approach with the pathologist. However, the endoscopist
does not need to be a pathologist. The pathologist is always a key partner
for endomicroscopy. but this technique will not make the pathologist
unnecessary. In contrast, endomicroscopy will help to select and target
biopsies and will surely help to avoid unnecessary biopsies. The pathologist
will be supplied with further information. Not only the endoscopic
appearance, but also subsurface details will guide the biopsy forceps. |
