Dr. Sharmila Anandasabapathy, director of endoscopy at The Mount Sinai Hospital in New York, explains how a laser performs imaging of the very superficial lining of the esophagus and what patients can expect when having the procedure. Testing prov...
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What is Confocal Microendoscopy? Dr. Sharmila Anandasabapathy: Confocal Microendoscopy is really a remarkable innovation, an addition to the endoscopic armamentarium. Essentially in a confocal examination either a catheter-based microscope or microscope which has been integrated into the endoscope is passed into the esophagus of the patent. The device has a laser, essentially at a very low wavelength, which performs imaging of those very, very superficial lining of the esophagus, it images to a depth of about 250 microns. So images that very superficial epithelium of the esophagus. The patients are usually given a fluorescent contrast agent this can either be a topical contrast agent or intravenous contrast agent. We often use Intravenous Fluorescein the same as what the opthamologists use for renal angiography. After the injection of fluorescein when we gently position the confocal scope against the lining of the esophagus what were able to obtain are two views. A standard endoscopic view of the esophagus what we call a white line endoscopic view and simultaneously a microscopic view of the esophagus at an 1100X magnification. This enables us to distinguish at a pathologic level normal esophageal lining from precancerous Barrett's esophagus what is known as dysplasia from cancer actually and we can see this at a very very high level of resolution and the images are at a sub-cellular level. So, really, really remarkable; we can see dysplasia and cancer at a very early stage and we can use this technology to target our biopsies and also to target areas for endoscopic mucosal resection. Most the procedures are done with sedation either highly conscious sedation what we call twilight or with what we call MAC anesthesia which is administered by an anesthesiologist and monitored in anesthesia care. The procedure lasts on average about 6 to 10 minutes. Currently Confocal Microendoscopy is actually in clinical trials in five centers throughout the world. In New York, Mount Sinai is actually the only center where this scope is in clinical trial and so if you do live in the greater New York area you do have the opportunity down to go a Confocal Microendoscopy examination.

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