Chromoscopic endomicroscopy: In vivo cellular resolution imaging of the colorectum

Advances in imaging technology and engineering have now permitted functional integration of a confocal endomicroscope into the distal tip of a conventional video colonoscope enabling imaging of the surface epithelium and the underlying lamina propria during ongoing video endoscopy. For the first time, the endoscopist is now able to resolve the surface and subsurface mucosa at cellular resolution in vivo and in real time. A new era in endoscopic imaging has therefore begun – histoendoscopy. In addition to providing a high-accuracy in vivo optical biopsy tool for the differentiation between benign hyperplasia, intra-epithelial neoplasia and carcinoma in sporadic cohorts, endomicroscopy with targeted biopsies has now been shown to increase the yield of intra-epithelial neoplasia complicating ulcerative colitis. Furthermore, recent data examining endomicroscopic molecular ex vivo imaging using anti-CD44v6 antibody has identified aberrant crypt foci based on their surface molecular expression. Receptor overexpression in vivo in humans may, in the near future, be exploited for the diagnosis of inflammation, neoplasia and in predicting targeted molecular therapy. Endomicroscopy will be key to this immuno-imaging interface. Within the present review, we discuss the current clinical evidence in support of confocal endomicroscopy and explore the new diagnostic possibilities for this technology.     

Combination endo‐radiological colorectal stenting: a prospective 5‐year clinical evaluation

Objective Self‐expanding metallic stents have found increasing use in the palliation of malignant large‐bowel obstruction or as a ‘bridge to surgery’ to facilitate a planned operative procedure. We describe a 5‐year experience of using the combined endoscopic/fluoroscopic through‐the‐scope method of stent placement in a tertiary referral centre. Method A prospective database of patients referred for colorectal stenting was compiled. Technical success, clinical success (decompression) and procedure‐related complications were measured as end‐points. Results Sixty‐three patients underwent 71 stenting procedures; 39 (62%) patients were male and the median age of patients was 78 years; 32 patients had metastatic disease and seven strictures were due to extrinsic compression. The indication for stenting was palliation in 56 patients and preoperative in seven patients. There was a technical success rate of 91% and a clinical success rate of 89%. Complications occurred in 24% of the cohort: overgrowth, (8%), migration (6%), fistulation (4%), stent fracture (3%), tenesmus (3%) and faecal urgency (1%). There was no procedure‐related death within the cohort and no technical failures proximal to the descending colon. Conclusion Combination endoscopic/fluoroscopic colorectal stenting is effective and safe. It may be particularly useful in the stenting of more proximal colonic strictures.