The Experts below are selected from a list of 5571 Experts worldwide ranked by ideXlab platform
Ralf Kiesslich - One of the best experts on this subject based on the ideXlab platform.
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Diagnostic Value of Endomicroscopy for Gastrointestinal Diseases: New Possibilities and Concepts
Techniques and Innovations in Gastrointestinal Endoscopy, 2021Co-Authors: Ralf KiesslichAbstract:ABSTRACT Endomicroscopy is a disruptive endoscopic technology which was firstly introduced in 2004. Endomicroscopy provides real-time cellular and vascular analysis of the mucosa during ongoing endoscopy. Endomicroscopy provides immediate in vivo histological diagnosis and lead to targeted biopsies and endoscopic interventions. Furthermore, Endomicroscopy enables functional and molecular imaging. Functional imaging can most recently be used to identify atypical food allergies or to predict relapse in inflammatory bowel diseases. Molecular imaging is still an evolving technology where distinct molecular characteristics of singular cells can be identified, quantified, and individual function can be determined. The scientific evidence of Endomicroscopy is very high but widespread of the technology into clinical routine has not yet completely achieved. Endomicroscopy is highly examiner dependent, needs some additional time during endoscopic imaging, interacts with conventional histology and other emerging endoscopic imaging tools have in some respects supersede Endomicroscopy. This review reflects the achievements of Endomicroscopy and provides and comprehensive overview about new possibilities and emerging concepts.
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Beyond Standard Image- enhanced Endoscopy Confocal Endomicroscopy
Gastrointestinal endoscopy clinics of North America, 2014Co-Authors: Daniel Teubner, Ralf Kiesslich, Takayuki Matsumoto, Johannes W. Rey, Arthur HoffmanAbstract:Endomicroscopy is a new imaging tool for gastrointestinal endoscopy. In vivo histology becomes possible at subcellular resolution during ongoing colonoscopy. Panchromoendoscopy with targeted biopsies has become the method of choice for surveillance of patients with inflammatory bowel disease. Endomicroscopy can be added after chromoendoscopy to clarify whether standard biopsies are needed. This smart biopsy concept can increase the diagnostic yield of intraepithelial neoplasia and substantially reduce the need for biopsies. Clinical acceptance is increasing because of a multitude of positive studies about the diagnostic value of Endomicroscopy. Smart biopsies, functional imaging, and molecular imaging may represent the future for Endomicroscopy.
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Endomicroscopy and endocytoscopy in IBD.
Gastrointestinal endoscopy clinics of North America, 2013Co-Authors: Helmut Neumann, Ralf KiesslichAbstract:Two types of Endomicroscopy systems exist. One is integrated into a standard, high-resolution endoscope and one is probe-based, capable of passage through the working channel of a standard endoscope. Endocytoscopy allows visualization of the superficial mucosal layer. Endoscope-integrated and probe-based devices allow magnification of the mucosa up to 1400-fold. Endomicroscopy can differentiate histologic changes of Crohn disease and ulcerative colitis in vivo in real time. Endocytoscopy can discriminate mucosal inflammatory cells, allowing determination of histopathologic activity of ulcerative colitis. Molecular imaging with fluorescence-labeled probes against disease-specific receptors will enable individualized management of inflammatory bowel diseases.
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Endomicroscopy, endocytoscopy, and autofluorescence for polyp characterization
Techniques in Gastrointestinal Endoscopy, 2013Co-Authors: Ralf Kiesslich, Arthur Hoffman, Helmut NeumannAbstract:This mini review deals with autofluorescence and cellular imaging using Endomicroscopy or endocytoscopy during colonoscopy. Autofluorescence can be used to detect and characterize colorectal lesions whereas Endomicroscopy and endocytoscopy are techniques to characterize colonic polyps based on cellular and subcellular patterns.
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local barrier dysfunction identified by confocal laser Endomicroscopy predicts relapse in inflammatory bowel disease
Gut, 2012Co-Authors: Ralf Kiesslich, Martin Goetz, Peter R Galle, Markus F Neurath, Carrie A. Duckworth, Driffa Moussata, A Gloeckner, L G Lim, David M. Pritchard, Alastair J.m. WatsonAbstract:Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal Endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods Confocal Endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal Endomicroscopy in humans was devised and used to predict relapse in a prospective pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn’s disease. Results Confocal Endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium. Mouse experiments demonstrated inward flow through some leakage-associated shedding events, which was increased when luminal osmolarity was decreased. In IBD patients in clinical remission, increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination (p<0.001). The sensitivity, specificity and accuracy for the grading system to predict a flare were 62.5% (95% CI 40.8% to 80.4%), 91.2% (95% CI 75.2 to 97.7) and 79% (95% CI 57.7 to 95.5), respectively. Conclusions Cell shedding and barrier loss detected by confocal Endomicroscopy predicts relapse of IBD and has potential as a diagnostic tool for the management of the disease.
Guang-zhong Yang - One of the best experts on this subject based on the ideXlab platform.
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Line scanning, fiber bundle fluorescence HiLo Endomicroscopy with confocal slit detection
Journal of biomedical optics, 2019Co-Authors: Haojie Zhang, Khushi Vyas, Guang-zhong YangAbstract:Fiber bundle fluorescence Endomicroscopy is an effective method for in vivo imaging of biological tissue samples. Line-scanning confocal laser Endomicroscopy realizes confocal imaging at a much higher frame rate compared to the point scanning system, but with reduced optical sectioning. To address this problem, we describe a fiber bundle Endomicroscopy system that utilizes the HiLo technique to enhance the optical sectioning while still maintaining high image acquisition rates. Confocal HiLo Endomicroscopy is achieved by synchronizing the scanning hybrid-illumination laser line with the rolling shutter of a CMOS camera. An evident improvement of axial sectioning is achieved as compared to the line-scanning confocal Endomicroscopy without the HiLo technique. Comparisons are also made with epifluorescence Endomicroscopy with and without HiLo. The optical sectioning enhancement is demonstrated on lens tissue as well as porcine kidney tissue.
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fiber bundle shifting Endomicroscopy for high resolution imaging
Biomedical Optics Express, 2018Co-Authors: Khushi Vyas, Michael Hughes, Bruno M G Rosa, Guang-zhong YangAbstract:Flexible endomicroscopes commonly use coherent fiber bundles with high core densities to facilitate high-resolution in vivo imaging during endoscopic and minimally-invasive procedures. However, under-sampling due to the inter-core spacing limits the spatial resolution, making it difficult to resolve smaller cellular features. Here, we report a compact and rapid piezoelectric transducer (PZT) based bundle-shifting Endomicroscopy system in which a super-resolution (SR) image is restored from multiple pixelation-limited images by computational means. A miniaturized PZT tube actuates the fiber bundle behind a GRIN micro-lens and a Delaunay triangulation based algorithm reconstructs an enhanced SR image. To enable real-time cellular-level imaging, imaging is performed using a line-scan confocal laser endomicroscope system with a raw frame rate of 120 fps, delivering up to 2 times spatial resolution improvement for a field of view of 350 µm at a net frame rate of 30 fps. The resolution enhancement is confirmed using resolution phantoms and ex vivo fluorescence Endomicroscopy imaging of human breast specimens is demonstrated.
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ICRA - A Framework for Sensorless Tissue Motion Tracking in Robotic Endomicroscopy Scanning
2018 IEEE International Conference on Robotics and Automation (ICRA), 2018Co-Authors: Pavlos Triantafyllou, Piyamate Wisanuvej, Stamatia Giannarou, Jindong Liu, Guang-zhong YangAbstract:Recent advances in probe-based Confocal Laser Endomicroscopy (pCLE) enable real-time, in situ and in vivo tissue assessment at the micro scale. The limited field-of-view offered by pCLE necessitates the use of mosaicking to allow for accurate tissue characterization from the incoming image stream. However, mosaicking requires a series of contiguous good-quality images, which is particularly challenging because probe-tissue distance must be maintained within a very narrow working range at all times and probe-tissue contact force must be kept to a minimum so that tissue deformation is avoided. Robotic manipulation of the Endomicroscopy probe has provided partial solution to these challenges, but sensorless approaches have not been thoroughly investigated up to date. This paper proposes a novel sensorless framework that uses a single non-reference image-quality metric to learn an approximation of tissue motion and subsequently track it. Moreover, a pCLE robotic tool for autonomous Endomicroscopy scanning is designed and used for testing and validation purposes. Experiments on lens paper and $ex$ vivo porcine tissue validate the philosophy of the framework.
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ICRA - Autonomous scanning for endomicroscopic mosaicing and 3D fusion
2017 IEEE International Conference on Robotics and Automation (ICRA), 2017Co-Authors: Lin Zhang, Petros Giataganas, Menglong Ye, Michael Hughes, Guang-zhong YangAbstract:Robot-assisted minimally invasive surgery can benefit from the automation of common, repetitive or well-defined but ergonomically difficult tasks. One such task is the scanning of a pick-up Endomicroscopy probe over a complex, undulating tissue surface to enhance the effective field-of-view through video mosaicing. In this paper, the da Vinci® surgical robot, through the dVRK framework, is used for autonomous scanning and 2D mosaicing over a user-defined region of interest. To achieve the level of precision required for high quality mosaic generation, which relies on sufficient overlap between consecutive image frames, visual servoing is performed using a combination of a tracking marker attached to the probe and the Endomicroscopy images themselves. The resulting sub-millimetre accuracy of the probe motion allows for the generation of large mosaics with minimal intervention from the surgeon. Images are streamed from the endomicroscope and overlaid live onto the surgeons view, while 2D mosaics are generated in real-time, and fused into a 3D stereo reconstruction of the surgical scene, thus providing intuitive visualisation and fusion of the multi-scale images. The system therefore offers significant potential to enhance surgical procedures, by providing the operator with cellular-scale information over a larger area than could typically be achieved by manual scanning.
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autonomous scanning for endomicroscopic mosaicing and 3d fusion
International Conference on Robotics and Automation, 2017Co-Authors: Lin Zhang, Petros Giataganas, Menglong Ye, Michael Hughes, Guang-zhong YangAbstract:Robot-assisted minimally invasive surgery can benefit from the automation of common, repetitive or well-defined but ergonomically difficult tasks. One such task is the scanning of a pick-up Endomicroscopy probe over a complex, undulating tissue surface to enhance the effective field-of-view through video mosaicing. In this paper, the da Vinci® surgical robot, through the dVRK framework, is used for autonomous scanning and 2D mosaicing over a user-defined region of interest. To achieve the level of precision required for high quality mosaic generation, which relies on sufficient overlap between consecutive image frames, visual servoing is performed using a combination of a tracking marker attached to the probe and the Endomicroscopy images themselves. The resulting sub-millimetre accuracy of the probe motion allows for the generation of large mosaics with minimal intervention from the surgeon. Images are streamed from the endomicroscope and overlaid live onto the surgeons view, while 2D mosaics are generated in real-time, and fused into a 3D stereo reconstruction of the surgical scene, thus providing intuitive visualisation and fusion of the multi-scale images. The system therefore offers significant potential to enhance surgical procedures, by providing the operator with cellular-scale information over a larger area than could typically be achieved by manual scanning.
Markus F Neurath - One of the best experts on this subject based on the ideXlab platform.
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Confocal laser Endomicroscopy for diagnosing lung cancer in vivo
2016Co-Authors: Michael Vieth, Markus F NeurathAbstract:ABSTRACT: Confocal laser Endomicroscopy is a novel endoscopic technique that may allow imaging of living cells in lung tissue in vivo. We assessed the potential of this technique for the detection of histology during screening bronchoscopy for lung cancer. 32 patients with suspected malignancies underwent bronchoscopy with Endomicroscopy using acriflavine hydrochloride. Standardised areas and localised lesions were analysed by in vivo confocal imaging during bronchoscopy and biopsies were taken. Confocal images were graded and correlated prospectively with conventional histology from biopsies. Acriflavine hydrochloride yielded high-quality confocal images and strongly labelled airway epithelial cells. No side-effects were noted. 75 522 confocal images from 56 different locations were compared prospectively with histological data from biopsy specimens. Endomicroscopy allowed subsurface imaging with detailed analysis of cellular and subcellular structures. Neoplastic changes could be predicted with high accuracy (sensitivity 96.0%, specificity 87.1%, accuracy 91.0%). Confocal laser Endomicroscopy with acriflavine is a novel diagnostic tool for the analysis of living cells during bronchoscopy and permits virtual histology of neoplastic changes in the airways with high accuracy. This technique may enable the rapid diagnosis of neoplasia during ongoing endoscopy in patients with suspected lung cancer
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local barrier dysfunction identified by confocal laser Endomicroscopy predicts relapse in inflammatory bowel disease
Gut, 2012Co-Authors: Ralf Kiesslich, Martin Goetz, Peter R Galle, Markus F Neurath, Carrie A. Duckworth, Driffa Moussata, A Gloeckner, L G Lim, David M. Pritchard, Alastair J.m. WatsonAbstract:Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal Endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods Confocal Endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal Endomicroscopy in humans was devised and used to predict relapse in a prospective pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn’s disease. Results Confocal Endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium. Mouse experiments demonstrated inward flow through some leakage-associated shedding events, which was increased when luminal osmolarity was decreased. In IBD patients in clinical remission, increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination (p<0.001). The sensitivity, specificity and accuracy for the grading system to predict a flare were 62.5% (95% CI 40.8% to 80.4%), 91.2% (95% CI 75.2 to 97.7) and 79% (95% CI 57.7 to 95.5), respectively. Conclusions Cell shedding and barrier loss detected by confocal Endomicroscopy predicts relapse of IBD and has potential as a diagnostic tool for the management of the disease.
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Local barrier dysfunction identified by confocal laser Endomicroscopy predicts relapse in inflammatory bowel disease
Gut, 2011Co-Authors: Ralf Kiesslich, Martin Goetz, Peter R Galle, Markus F Neurath, Carrie A. Duckworth, Driffa Moussata, A Gloeckner, L G Lim, David M. Pritchard, Alastair J.m. WatsonAbstract:Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal Endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods Confocal Endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal Endomicroscopy in humans was devised and used to predict relapse in a prospective pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn’s disease. Results Confocal Endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium. Mouse experiments demonstrated inward flow through some leakage-associated shedding events, which was increased when luminal osmolarity was decreased. In IBD patients in clinical remission, increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination (p
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Confocal Laser Endomicroscopy: Technical Advances and Clinical Applications
Gastroenterology, 2010Co-Authors: Helmut Neumann, Ralf Kiesslich, Michael B. Wallace, Markus F NeurathAbstract:Since its introduction in 2004, confocal laser Endomicroscopy (CLE) has emerged as a valuable tool for gastrointestinal endoscopic imaging. Endomicroscopy enables the endoscopist to obtain real time in vivo histology during ongoing endoscopy thereby creating “optical biopsies.” To date, numerous studies have shown potential applications of Endomicroscopy in the clinical setting, including in vivo diagnosis of esophageal squamous cell carcinoma, Barrett’s esophagus, celiac disease, and colonic polyps. Moreover, recent data suggest the potential application of Endomicroscopy in the field of molecular imaging. Additionally, in recent months new applications and developments in the field of confocal imaging were introduced including Endomicroscopy of the liver, pancreatic, and bile ducts. Furthermore, by introducing a new needle-based confocal imaging system, which is small enough to be introduced through a 22gauge puncture needle, a wide field for new applications of endomicroscopic imaging has been opened. Currently, 2 CE- and US Food and Drug Administration (FDA)approved devices for Endomicroscopy are available (Figures 1 and 2; Supplementary Table 1). In this review, we introduce both systems and discuss new technical advances and clinical applications of CLE.
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simultaneous confocal laser Endomicroscopy and chromoendoscopy with topical cresyl violet
Gastrointestinal Endoscopy, 2009Co-Authors: Martin Goetz, Arthur Hoffman, Peter R Galle, Peter M Delaney, Tanja Toermer, M Vieth, Kerry B Dunbar, Markus F Neurath, Ralf KiesslichAbstract:Background Confocal laser Endomicroscopy (CLE) has been shown to reliably predict histology during ongoing endoscopy. To unmask lesions for CLE, chromoendoscopy has been mandated. Usually fluorescein then serves as a contrast agent for CLE, but it does not allow direct nuclear visualization, must be injected, leads to a transient skin discoloration, and may have allergic side effects. Objective To establish a single topical dye, cresyl violet (CV), for simultaneous chromoendoscopy and in vivo CLE of the lower GI tract. Design Animal preclinical study, prospective clinical trial. Setting Mainz University Clinic (tertiary care center). Patients, Methods, and Interventions To establish the staining characteristics and optimal concentration of CV, the ileum and colon of 7 BL6 mice were stained with CV (0.1%-2%), and in vivo confocal imaging was performed with FIVE1. In a subsequent clinical trial, 67 sites in 36 patients were topically stained with CV 0.13%, and subsurface serial images were generated at different depths with an endomicroscope. Main Outcome Measurements Prediction of histology according to the Mainz confocal classification and nuclear visualization with topical CV. Results Endomicroscopy with topical CV yielded (sub-)cellular details of normal mucosa, and regenerative and neoplastic changes at variable imaging depths in high resolution comparable to those with intravenous fluorescein. By cytoplasmic enrichment of CV, nuclear morphology could be negatively visualized. Reliable differentiation of nonneoplastic versus neoplastic changes during ongoing endoscopy and a high interobserver agreement based on the microscopic images generated in vivo could be achieved. Limitations Single-center study, nonrandomized, limited number of patients. Conclusions CV can be applied topically and allows simultaneous chromoendoscopy and Endomicroscopy with accurate prediction of histology with visualization of nuclear morphology. It may therefore be a single-agent alternative to chromoendoscopy and fluorescein in Endomicroscopy.
Martin Goetz - One of the best experts on this subject based on the ideXlab platform.
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local barrier dysfunction identified by confocal laser Endomicroscopy predicts relapse in inflammatory bowel disease
Gut, 2012Co-Authors: Ralf Kiesslich, Martin Goetz, Peter R Galle, Markus F Neurath, Carrie A. Duckworth, Driffa Moussata, A Gloeckner, L G Lim, David M. Pritchard, Alastair J.m. WatsonAbstract:Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal Endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods Confocal Endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal Endomicroscopy in humans was devised and used to predict relapse in a prospective pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn’s disease. Results Confocal Endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium. Mouse experiments demonstrated inward flow through some leakage-associated shedding events, which was increased when luminal osmolarity was decreased. In IBD patients in clinical remission, increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination (p<0.001). The sensitivity, specificity and accuracy for the grading system to predict a flare were 62.5% (95% CI 40.8% to 80.4%), 91.2% (95% CI 75.2 to 97.7) and 79% (95% CI 57.7 to 95.5), respectively. Conclusions Cell shedding and barrier loss detected by confocal Endomicroscopy predicts relapse of IBD and has potential as a diagnostic tool for the management of the disease.
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Local barrier dysfunction identified by confocal laser Endomicroscopy predicts relapse in inflammatory bowel disease
Gut, 2011Co-Authors: Ralf Kiesslich, Martin Goetz, Peter R Galle, Markus F Neurath, Carrie A. Duckworth, Driffa Moussata, A Gloeckner, L G Lim, David M. Pritchard, Alastair J.m. WatsonAbstract:Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease (IBD). Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation. The objectives of the study were (1) to determine whether cell shedding and barrier loss in humans can be detected by confocal Endomicroscopy and (2) whether these parameters predict relapse of IBD. Methods Confocal Endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction. A grading system based on appearances at confocal Endomicroscopy in humans was devised and used to predict relapse in a prospective pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn’s disease. Results Confocal Endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium. Mouse experiments demonstrated inward flow through some leakage-associated shedding events, which was increased when luminal osmolarity was decreased. In IBD patients in clinical remission, increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination (p
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Advances of Endomicroscopy for gastrointestinal physiology and diseases
American journal of physiology. Gastrointestinal and liver physiology, 2010Co-Authors: Martin Goetz, Ralf KiesslichAbstract:Confocal Endomicroscopy is a novel technique that permits in vivo microscopy of the human gastrointestinal mucosa during ongoing endoscopy, thereby providing optical virtual biopsies. Endomicroscop...
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simultaneous confocal laser Endomicroscopy and chromoendoscopy with topical cresyl violet
Gastrointestinal Endoscopy, 2009Co-Authors: Martin Goetz, Arthur Hoffman, Peter R Galle, Peter M Delaney, Tanja Toermer, M Vieth, Kerry B Dunbar, Markus F Neurath, Ralf KiesslichAbstract:Background Confocal laser Endomicroscopy (CLE) has been shown to reliably predict histology during ongoing endoscopy. To unmask lesions for CLE, chromoendoscopy has been mandated. Usually fluorescein then serves as a contrast agent for CLE, but it does not allow direct nuclear visualization, must be injected, leads to a transient skin discoloration, and may have allergic side effects. Objective To establish a single topical dye, cresyl violet (CV), for simultaneous chromoendoscopy and in vivo CLE of the lower GI tract. Design Animal preclinical study, prospective clinical trial. Setting Mainz University Clinic (tertiary care center). Patients, Methods, and Interventions To establish the staining characteristics and optimal concentration of CV, the ileum and colon of 7 BL6 mice were stained with CV (0.1%-2%), and in vivo confocal imaging was performed with FIVE1. In a subsequent clinical trial, 67 sites in 36 patients were topically stained with CV 0.13%, and subsurface serial images were generated at different depths with an endomicroscope. Main Outcome Measurements Prediction of histology according to the Mainz confocal classification and nuclear visualization with topical CV. Results Endomicroscopy with topical CV yielded (sub-)cellular details of normal mucosa, and regenerative and neoplastic changes at variable imaging depths in high resolution comparable to those with intravenous fluorescein. By cytoplasmic enrichment of CV, nuclear morphology could be negatively visualized. Reliable differentiation of nonneoplastic versus neoplastic changes during ongoing endoscopy and a high interobserver agreement based on the microscopic images generated in vivo could be achieved. Limitations Single-center study, nonrandomized, limited number of patients. Conclusions CV can be applied topically and allows simultaneous chromoendoscopy and Endomicroscopy with accurate prediction of histology with visualization of nuclear morphology. It may therefore be a single-agent alternative to chromoendoscopy and fluorescein in Endomicroscopy.
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Confocal Endomicroscopy: a novel application for imaging of oral and oropharyngeal mucosa in human
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated wi, 2009Co-Authors: Boris R. Haxel, Martin Goetz, Ralf Kiesslich, Jan GosepathAbstract:Confocal Endomicroscopy is an emerging technique for intravital visualization of neoplastic lesions, but its use has so far been limited to the gastrointestinal (GI) tract. This study was designed to assess the feasibility of in vivo confocal Endomicroscopy of different regions of the oropharyngeal mucosa and to evaluate different contrast agents. We examined five different regions of the human oropharynx in vivo, and images were collected in real time by using a confocal laser endoscope as formerly described for the GI tract. Additionally ex vivo specimens were examined using a topical contrast agent. Confocal scanning was performed at 488-nm illumination for excitation of exogenously applied fluorophores (topical acriflavine and intravenous fluorescein). Confocal Endomicroscopy allowed for visualization of cellular and subcellular structures of the anterior human oropharyngeal region. Fluorescein staining yielded architectural details of the surface epithelium and also subepithelial layers. Images taken at increasing depth beneath the epithelium showed the mucosal capillary network. Acriflavine strongly contrasted the cell nuclei of the surface epithelium. The findings correlated well with the histology of biopsy specimens. This is the first report showing that the use of fluorescence confocal Endomicroscopy represents a promising method to examine cellular details in vivo in different oropharyngeal regions in human.
Michael Hughes - One of the best experts on this subject based on the ideXlab platform.
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fiber bundle shifting Endomicroscopy for high resolution imaging
Biomedical Optics Express, 2018Co-Authors: Khushi Vyas, Michael Hughes, Bruno M G Rosa, Guang-zhong YangAbstract:Flexible endomicroscopes commonly use coherent fiber bundles with high core densities to facilitate high-resolution in vivo imaging during endoscopic and minimally-invasive procedures. However, under-sampling due to the inter-core spacing limits the spatial resolution, making it difficult to resolve smaller cellular features. Here, we report a compact and rapid piezoelectric transducer (PZT) based bundle-shifting Endomicroscopy system in which a super-resolution (SR) image is restored from multiple pixelation-limited images by computational means. A miniaturized PZT tube actuates the fiber bundle behind a GRIN micro-lens and a Delaunay triangulation based algorithm reconstructs an enhanced SR image. To enable real-time cellular-level imaging, imaging is performed using a line-scan confocal laser endomicroscope system with a raw frame rate of 120 fps, delivering up to 2 times spatial resolution improvement for a field of view of 350 µm at a net frame rate of 30 fps. The resolution enhancement is confirmed using resolution phantoms and ex vivo fluorescence Endomicroscopy imaging of human breast specimens is demonstrated.
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ICRA - Autonomous scanning for endomicroscopic mosaicing and 3D fusion
2017 IEEE International Conference on Robotics and Automation (ICRA), 2017Co-Authors: Lin Zhang, Petros Giataganas, Menglong Ye, Michael Hughes, Guang-zhong YangAbstract:Robot-assisted minimally invasive surgery can benefit from the automation of common, repetitive or well-defined but ergonomically difficult tasks. One such task is the scanning of a pick-up Endomicroscopy probe over a complex, undulating tissue surface to enhance the effective field-of-view through video mosaicing. In this paper, the da Vinci® surgical robot, through the dVRK framework, is used for autonomous scanning and 2D mosaicing over a user-defined region of interest. To achieve the level of precision required for high quality mosaic generation, which relies on sufficient overlap between consecutive image frames, visual servoing is performed using a combination of a tracking marker attached to the probe and the Endomicroscopy images themselves. The resulting sub-millimetre accuracy of the probe motion allows for the generation of large mosaics with minimal intervention from the surgeon. Images are streamed from the endomicroscope and overlaid live onto the surgeons view, while 2D mosaics are generated in real-time, and fused into a 3D stereo reconstruction of the surgical scene, thus providing intuitive visualisation and fusion of the multi-scale images. The system therefore offers significant potential to enhance surgical procedures, by providing the operator with cellular-scale information over a larger area than could typically be achieved by manual scanning.
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autonomous scanning for endomicroscopic mosaicing and 3d fusion
International Conference on Robotics and Automation, 2017Co-Authors: Lin Zhang, Petros Giataganas, Menglong Ye, Michael Hughes, Guang-zhong YangAbstract:Robot-assisted minimally invasive surgery can benefit from the automation of common, repetitive or well-defined but ergonomically difficult tasks. One such task is the scanning of a pick-up Endomicroscopy probe over a complex, undulating tissue surface to enhance the effective field-of-view through video mosaicing. In this paper, the da Vinci® surgical robot, through the dVRK framework, is used for autonomous scanning and 2D mosaicing over a user-defined region of interest. To achieve the level of precision required for high quality mosaic generation, which relies on sufficient overlap between consecutive image frames, visual servoing is performed using a combination of a tracking marker attached to the probe and the Endomicroscopy images themselves. The resulting sub-millimetre accuracy of the probe motion allows for the generation of large mosaics with minimal intervention from the surgeon. Images are streamed from the endomicroscope and overlaid live onto the surgeons view, while 2D mosaics are generated in real-time, and fused into a 3D stereo reconstruction of the surgical scene, thus providing intuitive visualisation and fusion of the multi-scale images. The system therefore offers significant potential to enhance surgical procedures, by providing the operator with cellular-scale information over a larger area than could typically be achieved by manual scanning.
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Flexible Robotic Scanning Device for Intraoperative Endomicroscopy in MIS
IEEE ASME Transactions on Mechatronics, 2017Co-Authors: Siyang Zuo, Michael Hughes, Guang-zhong YangAbstract:Optical biopsy methods such as probe-based confocal Endomicroscopy can provide intraoperative real-time assessment of tumour margins, including during minimally invasive surgery with flexible endoscopes or robotic platforms. Mosaics can be produced by translating the probe across the target, but it remains difficult to scan over a large field of view with a flexible endomicroscope. In this paper, we have developed a novel flexible scanning device for intraoperative Endomicroscopy in minimally invasive surgery (MIS). A Schott leached imaging bundle was integrated into the device and enables the approach, via a flexible path, to deep and narrow spaces in the human body that otherwise would not accessible. The proposed device uses a gear-based flexible concentric tube scanning mechanism to facilitate large field-of-view mosaicing. Experimental results show that the device is able to scan different surface trajectories (e.g., a spiral pattern over a hemi-spherical surface). Results from lens tissue paper and porcine liver tissue are demonstrated, illustrating a viable scanning approach for Endomicroscopy in MIS.
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line scanning fiber bundle Endomicroscopy with a virtual detector slit
Biomedical Optics Express, 2016Co-Authors: Michael Hughes, Guang-zhong YangAbstract:Coherent fiber bundles can be used to relay the image plane from the distal tip of an endomicroscope to an external confocal microscopy system. The frame rate is therefore determined by the speed of the microscope’s laser scanning system which, at 10-20 Hz, may be undesirably low for in vivo clinical applications. Line-scanning allows an increase in the frame rate by an order of magnitude in exchange for some loss of optical sectioning, but the width of the detector slit cannot easily be adapted to suit different imaging conditions. The rolling shutter of a CMOS camera can be used as a virtual detector slit for a bench-top line-scanning confocal microscope, and here we extend this idea to Endomicroscopy. By synchronizing the camera rolling shutter with a scanning laser line we achieve confocal imaging with an electronically variable detector slit. This architecture allows us to acquire every other frame with the detector slit offset by a known distance, and we show that subtracting this second image leads to improved optical sectioning.