Ultra high magnification endoscopy: Is seeing really believing?

摘要： Endoscopy is an indispensible diagnostic and thera-peutic instrument for gastrointestinal diseases. Endo-cytoscopy and confocal endomicroscopy are two types of ultra high magnification endoscopy techniques.Standard endoscopy allows for 50 × magnification,whereas endocytoscopy can magnify up to 1400 × and confocal endomicroscopy can magnify up to 1000 ×.These methods open the realm of real time micros copicevaluation of the GI tract, including cellular and subcellular structures. Confocal endomicroscopy has the additional advantage of being able to visualize subsurface structures. The use of high magnification endoscopy inconjunction with standard endoscopy allows for a real-time microscopic assessment of areas with macroscopic abnormalities, providing "virtual biopsies" with valuable information about cellular and subcellular changes. Thiscan minimize the number of biopsies taken at the time of endoscopy. The use of this technology may assistin detecting premalignant or malignant changes at anearlier state, allowing for earlier intervention and treatment. High magnification endoscopy has shown promising results in clinical trials for Barrett's esophagus,esophageal adenocarcinoma, esophageal squamous cell cancer, gastric cancer, celiac disease, colorectalcancer, and inflammatory bowel disease. As the use of high magnification endoscopy techniques increases,the clinical applications will increase as well. Of the two systems, only confocal endomicroscopy is currently commercially available. Like all new technologies there will be an initial learning curve before operators become proficient in obtaining high quality images and discerning abnormal from normal pathology. Validatedcriteria for the diagnosis of the various gastrointestinal diseases will need to be developed for each method. Inthis review, the basic principles of both modalities are discussed, along with their clinical applic ability and limitations. ... （共10页）