26 and involves the elimination of red wave light and narrowing of the bandwidth of blue (440–460 nm) and green (540–560 nm) wave light. This modified light penetrates the mucosa only
superficially, is mainly absorbed by hemoglobin and highlights surface details and microvascular patterns. The technique can be rapidly activated by a button on the endoscope and appears to be helpful for differentiating neoplastic from non-neoplastic Selleck MLN0128 colonic polyps, at least when performed by experienced endoscopists.27 Autofluorescence involves the excitation of endogenous biological substances (fluorophores) by short wave-length light that leads to the emission of a fluorescent light of longer wave-length. The potential use in endoscopy is based on differences in autofluorescence spectra with normal and neoplastic tissue. Already, prototype endoscopes have been produced that incorporate high resolution images, narrow band imaging and autofluorescence imaging
(trimodal imaging) but the diagnostic contribution of the latter is still unclear. The use of various diagnostic aids in a patient with Barrett’s esophagus is shown in Fig. 1. An important question for the future of endoscopy is the role of conventional histology. Ferroptosis inhibitor Will biopsies be taken in 2020–2030 or will pathologists interpret surface or other features in real-time or will responsibility for gastrointestinal pathology largely pass from the dedicated pathologist to the gastroenterologist? At a practical level, it would be helpful to rapidly and accurately differentiate hyperplastic from
adenomatous colonic polyps and to differentiate dysplastic Cyclic nucleotide phosphodiesterase from non-dysplastic tissue in Barrett’s esophagus. It would also be helpful to have a simple, single and highly accurate test for the identification of Helicobacter pylori. In relation to real-time histology, endoscopes such as the endocytoscope and confocal laser endomicroscope can already magnify surface features up to similar levels to those obtained with a high-power microscope (1000X). However, these or similar endoscopes are unlikely to enter mainstream gastroenterology in the near future because of costs, requirements for contrast agents and difficulties with the prediction of pathology based on surface characteristics. At present, narrow band imaging appears to be a simple and attractive diagnostic aid but whether it is accurate enough for ‘optical biopsy’ in a community setting has not been investigated. Future innovations may include molecular imaging techniques that use specific antibodies labelled with substances such as fluorescein that might be readily detected with inexpensive technologies. A current technique for imaging outside the bowel lumen is that of EUS. Important developments in the 1990s included the production of a curvilinear echo-endoscope and the description of fine-needle aspiration with aspiration cytology.