Examination technique

The confocal endoscope can be handled similarly to a standard endoscope. Initially white-light endoscopy is used to identify suspected lesions. Chromoendoscopy or i-scan (digital filter system imitating chromoendoscopy) can be used in addition to unmask flat or diminutive lesions. However, chromoendoscopy or i-scan neither interferes with the endomicroscopic system nor is it a prerequisite for confocal imaging.

 

After the application of contrast agent (intravenously or local) endomicroscopy becomes possible. A stable endoscope position is important to reduce movement artefacts. 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 after meticulous white light endoscopic inspection of the mucosa, because targeted endomicroscopy is much more effective than random endomicroscopy.

 

The position of the focal plane within the mucosal area of interest is adjusted using the buttons on the endoscope control body. Confocal 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. Images can be judged online. In addition, 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 histological and histopathological training and an interdisciplinary approach with the pathologist.