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

Kiesslich et al.
Current Opinion in Gastroenterology
ISSN: 0267-1379 • Frequency: 6/year • Impact Factor: 3.877 • Subscribe Now

Cancers of the gastrointestinal tract are associated with a poor prognosis in advanced stages of the disease, and curative treatment is usually only achieved in local disease. Therefore, early and rapid diagnosis is of paramount importance for the successful management of malignant lesions. Implementation of endoscopic screening programs aim at preventing cancer by resection of precursor lesions. These programs mandate accurate diagnosis even of minute and flat lesions that are at high risk of being missed with conventional endoscopy techniques.
Diagnostic gastrointestinal endoscopy therefore aims at satisfying three distinct needs. First and most obvious, endoscopy should be able to detect lesions and to differentiate circumscript alterations (with a potential for neoplasia) from diffuse changes in mucosal patterns. Second, endoscopy should be able to provide characterization of the tissue of interest. And third, histopathological confirmation should be sought. These steps mandate advanced endoscopy techniques, which should ideally translate into immediate 'on-table' clinical decision-making.
Diagnostic endoscopy is also used to evaluate the course of inflammatory or neoplastic diseases once diagnosis is established. By this, not only therapeutic decisions are guided, but also insight is gained into the pathophysiology of such diseases. Especially when physiologic processes are monitored, ex-vivo techniques inherently only provide a snapshot view onto the fixed and processed tissue. This may only incompletely render dynamic physiologic events. In this setting oriented towards clinical research, endomicroscopy established a role for endoscopy to visualize such processes in vivo.

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