Advanced imaging of the gastrointestinal tract: research vs. clinical tools?

Diagnostic endoscopy has moved forward considerably in the recent years. Still, three major needs have to be satisfied: endoscopy should be able to detect a lesion, characterize the lesion, and then its nature should be confirmed. These steps should ideally translate into an immediate therapeutic decision.

High definition endoscopy has optimized our endoscopic view onto the mucosa and can be combined with digital surface enhancement modalities. Chromoendoscopy still holds a place to detect especially flat lesions in high-risk patients such as ulcerative colitis. Digital chromoendoscopy techniques such as narrow band imaging, i-scan, or Fuji intelligent chromo endoscopy offer new possibilities of easily and reversibly obtaining enhanced tissue contrast. Autofluorescence imaging uses tissue function to yield a pseudocolored image, and has potential to serve as a red flag technique for the detection of neoplastic lesions. Confocal laser endomicroscopy has for the first time provided real time microscopy. In addition to visualizing morphology, functional and molecular imaging open new horizons for the gastroenterologist.

Advanced imaging techniques have provided the endoscopist with an armamentarium of novel modalities for detection, characterization and microscopy of lesions during endoscopy. In addition, functional and molecular imaging give insight into dynamic processes of tissues in their natural surroundings.