Volume 127, Issue 3, Pages 706-713 (September 2004) Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo  Ralf Kiesslich, Juergen Burg, Michael Vieth, Janina Gnaendiger, Meike Enders, Peter Delaney, Adrian Polglase, Wendy McLaren, Daniela Janell, Steven Thomas, Bernhard Nafe, Peter R. Galle, Markus F. Neurath  Gastroenterology  Volume 127, Issue 3, Pages 706-713 (September 2004) DOI: 10.1053/j.gastro.2004.06.050 Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 1 Distal end of the confocal colonoscope. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 2 Confocal images of normal colonic mucosa after application of topical acriflavine hydrochloride or intravenous administration of fluorescein sodium. (A) An image collected from the ascending colon following topical application of acriflavine hydrochloride, which strongly stained the superficial epithelial cells only. (B) In contrast, intravenous administration of fluorescein sodium resulted in strong staining of the surface epithelium (ascending colon, upper parts of the crypts) as well as the deeper layers of the lamina propria. (C) At deeper focal planes of the crypts, it was possible to visualize the subsurface microvasculature observed as a characteristically anastomosed honeycomb-like plexus around each crypt lumen. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 3 Confocal laser endomicroscopy of the terminal ileum and corresponding histology. (A) Ileal villi with visible capillary and erythrocytes. (B) Corresponding histologic specimen. 1, stroma; 2, capillary with erythrocytes; 3, goblet cells; 4, epithelial cells. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 4 Confocal laser endomicroscopy of normal rectum mucosa. (A) Round-shaped regular colonic crypts with black mucin visible within goblet cells. (B) Corresponding histologic specimen shows the nuclei within the epithelial layer. 1, goblet cells; 2, crypt lumen; 3, stroma; 4, nuclei. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 5 Aberrant crypt foci. (A) Aberrant crypts are visible after intravital staining with methylene blue in the sigmoid. Typical star-shaped crypt openings are visible (1). (B) Confocal imaging shows the fusion of regular-shaped crypts. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 6 Adenoma with high-grade intraepithelial neoplasia. (A) Videoendoscopy shows a large polyp. (B) Confocal laser endomicroscopy shows tubular-shaped crypts with a reduced amount of goblet cells and loss of cellular junctions. (C) Corresponding histologic specimen. 1, branched crypt structure in the area of intraepithelial neoplasia; 2, reduced amount of goblet cells; 3, loss of cellular junctions; 4, normal-shaped crypts. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions

Figure 7 Colorectal cancer. (A) Confocal laser endomicroscopy shows irregular cell architecture with total loss of goblet cells. (B) Corresponding histologic specimen. Gastroenterology 2004 127, 706-713DOI: (10.1053/j.gastro.2004.06.050) Copyright © 2004 American Gastroenterological Association Terms and Conditions