Endoscopy 2010; 42: E182
DOI: 10.1055/s-0029-1244005
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Description of a new technique using biopsy forceps to stabilize pedunculated polyps for confocal laser endomicroscopy (with video)

H.  Neumann1 , M.  Raithel1 , M.  F.  Neurath1
  • 1Department of Medicine I, University of Erlangen-Nuremberg, Germany
Further Information

H. Neumann
MD, PhD

Department of Medicine I
University of Erlangen-Nuremberg

Ulmenweg 18
91054 Erlangen
Germany

Phone: +49-9131-85-35000

Fax: +49-9131-85-35209

Email: helmut.neumann@uk-erlangen.de

Publication History

Publication Date:
16 July 2010 (online)

Table of Contents

The recently introduced technique of confocal laser endomicroscopy (CLE) enables in-vivo microscopic imaging of the mucosal layer of the gut at a subcellular resolution [1] [2]. Several studies have shown that CLE has the potential to accurately discriminate between adenomatous and nonadenomatous colorectal polyps, and to enable the evaluation of the degree of dysplasia during ongoing endoscopy [3] [4]. Nevertheless, in practice it is often difficult to receive confocal images of pedunculated polyps that are in focus because the polyps often “flap” away from the endoscope, which prevents stable contact between the confocal lens and the polyp tissue. We were confronted with this problem in a patient undergoing surveillance colonoscopy. A large, 15-mm, pedunculated polyp with Kudo pit pattern 3S was visualized in the proximal sigmoid. Despite the size of the polyp, it was not possible to receive confocal images in focus because the polyp was repeatedly pushed away by the endoscope (Pentax EC-3870 CIFK, Tokyo, Japan). By grasping the head of the polyp with a standard biopsy forceps we could pull the polyp toward the confocal lens ([Video 1]; [Fig. 1 a – c]) and receive high-quality confocal images on CLE of the polyp ([Video 1]; [Fig. 1 d]).

Zoom Image

Fig. 1 a – d The head of the pedunculated polyp was grasped with standard biopsy forceps and pulled toward the confocal lens to receive confocal images in focus.


Quality:

Video 1 As shown in [Fig. 1], the head of the pedunculated polyp was grasped with standard biopsy forceps and pulled toward the confocal lens to receive confocal images in focus. Note the blue laser light at the 7 o’clock position.

Although it is often difficult to perform CLE in pedunculated polyps we believe that the novel technique described here has the capability to considerably improve diagnostic outcomes.

Competing interests: None

Endoscopy_UCTN_Code_TTT_1AQ_2AB

#

References

H. Neumann
MD, PhD

Department of Medicine I
University of Erlangen-Nuremberg

Ulmenweg 18
91054 Erlangen
Germany

Phone: +49-9131-85-35000

Fax: +49-9131-85-35209

Email: helmut.neumann@uk-erlangen.de

#

References

H. Neumann
MD, PhD

Department of Medicine I
University of Erlangen-Nuremberg

Ulmenweg 18
91054 Erlangen
Germany

Phone: +49-9131-85-35000

Fax: +49-9131-85-35209

Email: helmut.neumann@uk-erlangen.de

Zoom Image

Fig. 1 a – d The head of the pedunculated polyp was grasped with standard biopsy forceps and pulled toward the confocal lens to receive confocal images in focus.