“A microscope is virtually taken piggyback by the endoscope to travel through the body”, explains Dr. Ralf Kießlich from the University Clinic Mainz, Germany, where the technique was developed and tested. “Thus one can make for example simultaneously a microscopy and an endoscopy in the intestine.”

When an endoscope for instance traverses through the colon and detects polyps, this does not necessarily mean that they will develop into a malignant tumour. “With the endomicroscope the physician can differentiate tissues during the examination and can thus decide which polyp should better be taken out and which one is harmless”, says the medical practitioner from Mainz.

During the examination a fluorescent contrast medium is either given intravenously or sprayed directly by the endoscope on the spot which is to be observed. Then laser light from the microscope shines onto the tissue and the examiner can detect details from individual cells. With the blue laser light the tissue can be observed from the surface to a depth of 250 micrometers. “Thus we can detect cancer at a pre-cancerous stage”, says Kießlich.

Endomicroscopy saves the pathologist a lot of work and time. “With this technique we can take fewer biopsies, because tissue specimen can be taken more precisely”, explains Kießlich. “The pathologist receives less samples but in all likelihood he will find evidence of the disease therein.”

So far endomicroscopy cannot replace a biopsy with a subsequent analysis. The kind of neoplasia can only be detected by the pathologist. However, Kießlich reckons: “Basically I do believe that in the future we will be able to reach a grade which equals histology.”

For the future Kießlich sees many applications for the technique apart from the stomach and intestine. “Advancements for the area of urology or neurology would be imaginable.” At the moment the researchers from Mainz test a development for the abdomen. “Just now we develop a small pencil that looks like a ballpen. Inside it is a microscope, so that when doing a laparoscopy we can scan the liver or the lymph node as well.”