L’endomicroscopie confocale: première expérience française
Confocal endomicroscopy: first French experience
For about 30 years, mucosal staining combined with magnifying lens endoscopes [2,3]have allowed for the early detection of superficial malignant lesions of the digestive tract and their treatment at a curable stage. The development of mucosectomy (technique and instruments) in parallel with the development of ultrasonography with very high frequencies or miniprobes, allowed for a more conservative curative treatment of these lesions when intra mucosal neoplasia has not infiltrated the muscularis mucosae [4, 5].
The wider use of vital staining is a major step forward for the endoscopic detection of digestive lesions. This technique using diluted indigo carmine had been already recommended by ANAES in the surveillance of HNPCC syndromes, of IBD or familial polyposis.
Recently, thanks to the introduction of 50 ×to 160 ×magnifying lenses, a better definition of endosocopic microanatomy is now widely accessible. This device allows for a minute study of the digestive mucosa and in case of atrophy, metaplasia or dysplasia, a visual signal can be evidenced. On colic polyps, the aspect of the glandular pits as well as their distribution orientates the operator to obtain targeted samples [6, 7].
The diagnostic accuracy currently provided by digestive endoscopy, has considerably benefited from confocal microscopy with its magnification up to 1000 ×.These real «optical biopsies», being ten folds more powerful than the opticalelectronic lens allow for an in vivo study of the cells of the digestive mucosa at a depth of 250 μ [8,9].
J.C. LETARD, Th. BARRIOZ