An endoscope for simultaneous macroscopic navigation and microscopic inspection of luminal sidewalls

Abstract

Endoscopic techniques are commonly used for esophageal and gastrointestinal screening. In this process, atypical regions are identified by gross visual and morphological changes. These regions are then biopsied for pathological confirmation prior to determining treatment. In an effort to increase the sensitivity of endoscopic screening, many groups have performed work in developing microscopic endoscopes capable of inspecting tissues on a cellular level. These microscopic endoscopes are generally implemented as either a stand-alone fiber or through the working channel of a traditional endoscope, and are oriented in a manner similar to traditional flexible endoscopes, imaging the region directly ahead of the endoscope with a wide-angle lens. However, this may not be the optimum configuration for microscopic inspection of luminal sidewalls. We present a novel optical configuration for an endoscope that can simultaneously function as a traditional forward-viewing macroscopic endoscope and as a sidewall-viewing microscopic endoscope. With the first prototype, we have realized a water-emersion microscopic that is capable of imaging tissues on a single-cell level. In addition, microscopic side-port configuration enables efficient mapping of the luminal wall. Utilizing simultaneous macroscopic and microscopic imaging, we are developing software for image registration and analysis that will enable localization of microscopic features within a macroscopic frame of reference. Through a combination of microscopic sidewall imaging and software for image analysis, we aim to provide the clinician with the equivalent of an in vivo biopsy, increasing screening effectiveness and decreasing discomfort and costs related to performing multiple biopsies of suspected regions.