Comfocal Laser Endomicroscopy (CLE) Cancer Diagnostic Tool: Immediate Diagnosis Without a Biopsy

The Gastrointestinal tract (GI tract) extends from the mouth to the anus, along a thirty foot long tube, entailing many different important bodily functions, and a worrisome area, which for many people develop chronic health concerns, may cause death. The Gastrointestinal tract functions: Take in food, extract energy and nutrients from digested food, and expels human waste. The GI tract is divided into two sections: Upper and lower gastrointestinal tract. The Upper GI tract includes the mouth, pharynx (behind the mouth), esophagus (hollow muscular tube), and diaphragm (Contraction of muscles referred to as peristalsis propel food down to the esophagus.). The lower GI tract includes the small intestines (Encompasses three parts: Duodenum, Jejunum and Ileum), large intestines (Encompasses three parts: Cecum, Colon and Rectum) and Anus (Fecal matter exists through the rectum 3). 2 Health concerns developing in the GI tract include: Crohn's Disease, Diverticulitis, Candidiasis, Colon Cancer, Irritable Bowel Disease, and Prolapsed Colon. These GI tract health problems are caused by trapped feces lining the intestinal tract, parasites nesting in the impacted feces and "Too much bad and not enough good bacteria in the Intestines". 4

A gastrointestinal endoscopy a flexible fiberoptic tube has a tiny TV camera at the end, manipulated by a physician to examine the entire GI tract for any diseases and provide treatment. During the procedure specimens can be removed or foreign objects or polyps (cancerous or benign) for a biopsy. 5 A pathologist examines polyps under a microscope to determine the type of polyp. 6 In 2007, Mauna Kea Technologies report developed a Confocal Laser Microscopic Probe or Confocal Laser Microscopic Endomicroscopy (15) (CLE), enhanced the conventional usage of the endoscopy by providing real - time video sequences (12 frames per second 14) or visual subsurface analysis of the gut mucosa or intestinal mucosa ("Mucosa is moist tissue that lines some organs and body cavities throughout the body, including your nose, mouth, lungs, and digestive tract. Glands along the mucosa release mucus (a thick fluid)." 7) magnified 500 - 1000 times greater. Because of the enhanced visual capability of the confocal laser microscopic probe, immediate diagnosis can be determined without taking a biopsy or time consuming intensive laboratory work.10 The CLE could lead to earlier diagnosis and treatment of gastrointestinal disorders such as reflux disease, cancer, and inflammatory bowel disease. 12 One of the many benefits of the confocal laser microscopic probe, diagnosis celiac disease. ("People who have celiac disease cannot tolerate a protein called gluten, found in wheat, rye, and barley. Ingesting gluten damages the small intestines and impedes the the absorption of nutrients from food." 8). 9 "To date, more than 1000 endomicroscopy procedures have been performed in the world and different publications have shown the safety, feasibility and excellent diagnostic yield of CLE." 10

Dr. Kerry B. Dunbar, a fellow in the division of gastroenterology and hepatology and author said regarding Confocal Laser Microscopic probe: "This is a very promising technique for real - time microscopic imaging of the gastrointestinal tract." According to study results by Dr. Dunbar and colleagues CLE was equally effective to diagnosis precancerous cells in people with Barrett's esophagus (The esoophagus is a muscular tube that carries food and saliva from the mouth to the stomach.13 Barret's esophagus Condition can preclude esophageal cancer), compared to taking a biopsy which is invasive and can cause bleeding. Mayo Clinic Jacksonville Florida researches confirmed the CLE is eighty-nine percent accurate diagnose colon polyps (Upper GI tract 15) and ninety-eight percent identify small benign polyps (lower GI tract 15), normally polyps would be removed for a biopsy. Dr. Anna M. Buchner and study author said: "This technique will fundamentally change how the two fields (endoscopy and pathology) interact. This procedure allows us to become endopathologists, and the result is that we will be able to better manage patients with gastrointestinal disorders". 11

Researchers discovered when staining (Referred to as Chromoendoscopy - topical application of stains or pigments 21) the colonic ("A colonic is the infusion of water into the rectum by a colon therapists to cleanse and flush out the colon." 16) mucosa with 0.1% methylene blue (dye), help identify neoplasia (group of diseases commonly called tumor or cancer 17) or suspicious lesions examined with a Confocal Laser Microscopic Endomicroscopy. 19 Other substances or dyes assist CLE visualize the surface and subsurface structures include: Acriflavine (Applied topically for imaging the stomach and colon) and fluorescein (Given intravenously for imaging the esophagus, stomach and colon). Physicians and staff observe on a gray - scale visual image of the surrounding anatomical areas, and can be enhanced by color to simulate the normal mucosal appearance. 23

The Confacol Laser Endomicroscopy good diagnostic tool help ulcerative colitis ("Ulcerative colitis is a disease that cause inflammation and sores, called ulcers in the lining of the rectum and colon." 18) patients prone to develop colorectal cancer. 19 Recommend after the onset of ulcerative colitis symptoms, screening colonoscopies following eight to ten years and follow-up examinations every 1 to 2 years, detect early diagnosis of cancer. 20 Early diagnosis of colorectal cancer stage inventively can prevent up to 90% of related deaths. 24 Dr. Ralf Keisslich, assistant professor, University of Mainz Germany reported a study examining 153 patients who were in remission from long - term ulcerative colitis. These patients under gone a CLE, identified neoplastic changes ("94.7% sensitivity and 98.3% specificity) with an overall accuracy of 97.8%. 19

Dr. Pankaj J. Pasricha, professor of medicine, gastroenterology and hepatology at Standford University School of Medicine said: "New technique such as those discussed will change the way we diagnose patients, allowing us to treat them more accurately, quickly and appropriately." 22

According to Dr.Ralf Kiesslich, the technique to learn how to use comfocal laser endomicroscopy ranges from one week learning imaging of normal tissue to three months learning the imaging of pathologic tissue. Compared to conventional endoscopy procedure the CLE adds ten to twenty minutes. In some cases, pathologist is still need to ascertain a definitive diagnosis. 23

Detailed information and video how the Confocal Laser Microscopic Probe works, including enhanced analysis of the mucosa after dye is injected (click onto Web-site link): Stomach - In vivo Imaging of H. Pylori with Endomicroscopy (January 2007) or visit the Web-Site Address: http://daveproject.org/ViewFilms.cfm?film_id=564

References:

1.) Human Physiology / The gastroinestinal system - http://en.wikibooks.org/wiki/Human_Physiology/The_gastrointestinal_system

2.) Gastrointestinal tract - http://en.wikipedia.org/wiki/Gastrointestinal_tract

3.) Rectum - http://en.wikipedia.org/wiki/Rectum

4.) The Gastrointestinal Tract - http://www.merc-buyers.com/gastrointestinal_tract.htm

5.) Gastrointestinal Endoscopy - http://www.emedicinehealth.com/gastrointestinal_endoscopy/article_em.htm

6.) Polyps - http://www.gicare.com/pated/eicnppab.htm

7.) Mucosa - http://www.pennhealth.com/ency/article/002264.htm

8.) Celiac Disease - http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

9.) New Improved Confocal Laser Endomicroscopy System - http://www.celiac.com/articles/21494/1/New-Improved-Confocal-Laser-Endomicroscopy-System/Page1.html

10.) Confocal Laser Endomicroscopy - http://clinicaltrials.gov/ct2/show/NCT00561938?recr=open&intr=colonoscopy&rank=8

11.) New Technology Speeds GI Disease Diagnosis - http://www.realage.com/news_features/Article.aspx?id=615569

12.) New Technology Speeds GI Disease Diagnosis - http://www.covenanthealth.org/HealthDay/5_2008/615569

13.) Barrett's Esophagus - http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/

14.) New Clinical Data on Cellvizio GI to be Presented at Digestive Disease Work 2008 - http://biz.yahoo.com/pz/080514/142738.html

15.) New Technology Speeds GI Disease Diagnosis - http://health.usnews.com/articles/health/healthday/2008/05/18/new-technology-speeds-gi-disease-diagnosis.html

16.) What is Colonic? - http://altmedicine.about.com/od/coloncleanse/a/colonic.htm

17.) Neoplasm - http://en.wikipedia.org/wiki/Neoplasia

18.) Ulcerative Colitis - http://digestive.niddk.nih.gov/ddiseases/pubs/colitis/

19.) Confocal Endomicroscopy Improves Diagnosis of Colitis - Associated Neoplasia - http://www.docguide.com/dg.nsf/PrintPrint/F73D66F8E18175D4852570030055B7D7

20.) Literature Review - Colorectal Cancer and Ulcerative Colitis - http://www.medscape.com/viewarticle/566844

21.) Chromoendoscopy - http://www.uptodate.com/patients/content/topic.do?topicKey=gi_endos/7593&title=undefined

22.) New Technology Speeds GI Disease Diagnosis - http://www.healthcentral.com/ibd/news-252166-31.html

23.) Confocal Laser Endomicroscopy Can Facilitate the Diagnosis of Both Esophageal and Gastric Cancers - http://www.cancernetwork.com/display/article/10165/109258

24. Colon Cancer Screening - http://www.uwgi.org/guidelines/ch_08/ch08txt.htm