Miniature Microscopes Improve GI Diagnosis, Treatment

Confocal microscopy—a high-definition imaging technology common in the lab—has now been miniaturized and is being used by Columbia physicians to see the GI tract in a way never before possible.

“Physicians began using the technology in clinical decision-making about two years ago, and it’s been a significant advance in our ability to diagnose gastrointestinal conditions,” says
Frank Gress, MD, professor of medicine and clinical chief of digestive diseases at NewYork-
Presbyterian/Columbia University Medical Center.

For decades, confocal microscopes have allowed scientists to obtain finely detailed and highly magnified images of biological tissues, but the equipment was bulky and restricted to the lab bench. Technological advances have now shrunk these microscopes down to several millimeters in diameter so they are suitable for clinical purposes. A miniaturized confocal microscope can be attached to a catheter and passed through the entire gastrointestinal tract and can also be used in the bile and pancreatic ducts.

Unlike an endoscopy procedure, the miniature microscope makes it possible for physicians to see underneath the surface of the tissue and inspect the microcellular structure of the GI tract.

The miniaturized technology is called probe-based confocal laser endomicroscopy (pCLE) and is produced by Mauna Kea Technologies under the name Cellvizio.

“Cellvizio allows us to do an optical biopsy and make a decision on the spot about an abnormal finding,” Dr. Gress says. “In the days before pCLE, we would image with our endoscope, take a biopsy, and then wait several days for the results. Now, we can go from evaluation to biopsy to interpretation in one session.”

Barrett’s esophagus is a condition that is strongly suited to the use of pCLE. “pCLE has the potential to detect more malignant or premalignant lesions through better sampling, especially in areas that appear normal under endoscopic examination.” In some cases, physicians have been able to perform minimally invasive treatments for conditions that traditionally required major surgery.

The technology also helps when using an endoscope to remove a lesion. “We can use pCLE to better define what we’re going to remove and also confirm that we’ve removed all of it,” says Dr. Gress.

pCLE also may help patients with chronic pancreatitis, pancreatic cysts, pancreatic and bile duct strictures and people with a family history of pancreatic cancer. In the case of pancreatic cysts, the technology is changing how patients are monitored for potential malignancies.

“We can put the confocal microscope into the pancreatic cyst and determine if a cyst is benign or potentially malignant just by looking at it,” says Dr. Gress. “Before, we had to extract fluid and biopsy samples and wait several weeks for all the results to come back. Presently, we are still taking tissue biopsies at this time to validate our pCLE findings, but in the future, we hope that current ongoing clinical trials will support making the determination without the physical biopsy.”

For more information, contact Dr. Gress at 212-305-1909.