Mucosal imaging advanced technologies in the gastrointestinal tract

The use of advanced imaging technologies to enhance visualization the gastrointestinal mucosa has evolved from being an experimental tool to a valuable adjunct in diagnostic and therapeutic endoscopy. Digital chromoendoscopy including narrow band imaging (NBI) has been incorporated into standard endoscopy systems as a practical instrument used to enhance the mucosal surface and microvasculature. NBI is now routinely used to evaluate mucosal irregularities associated with Barrett's esophagus dysplasia. A recent review of the literature suggests that NBI can be used to evaluate colorectal polyps and its use may even change our clinical management of diminutive polyps. Other technologies, such as confocal laser endomicroscopy (CLE) and optical coherence tomography require independent imaging systems with probes that can be deployed through an endoscope's instrument channel. The incorporation of these technologies into clinical practice has been limited by cost and need for expertise in image interpretation. High-magnification imaging with CLE can evaluate mucosal changes that are both sensitive and specific to various disease processes. CLE probes have a small field of view that makes evaluation of large areas of the gastrointestinal tract time consuming. A second-generation optical coherence tomography system also known as volumetric laser endomicroscopy is capable of wide-field cross-sectional imaging of the human esophagus. New technologies, including second-generation digital chromoendoscopy blue-laser imaging are currently under study. Development and utilization of advanced imaging technologies has been critical in the rapid pace of advances in diagnostic and therapeutic endoscopy in the past decade.