Position paper: The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

Environmental enteric dysfunction (EED) is a disease of the small intestine affecting children and adults in low and middle income countries. Arising as a consequence of repeated infections, gut inflammation results in impaired intestinal absorptive and barrier function, leading to poor nutrient uptake and ultimately to stunting and other developmental limitations. Progress towards new biomarkers and interventions for EED is hampered by the practical and ethical difficulties of cross-validation with the gold standard of biopsy and histology. Optical biopsy techniques — which can provide minimally invasive or noninvasive alternatives to biopsy — could offer other routes to validation and could potentially be used as point-of-care tests among the general population. This Consensus Statement identifies and reviews the most promising candidate optical biopsy technologies for applications in EED, critically assesses them against criteria identified for successful deployment in developing world settings, and proposes further lines of enquiry. Importantly, many of the techniques discussed could also be adapted to monitor the impaired intestinal barrier in other settings such as IBD, autoimmune enteropathies, coeliac disease, graft-versus-host disease, small intestinal transplantation or critical care

Removal of back-reflection noise at ultrathin imaging probes by the single-core illumination and wide-field detection

Thin waveguides such as graded-index lenses and fiber bundles are often used as imaging probes for high-resolution endomicroscopes. However, strong back-reflection from the end surfaces of the probes makes it difficult for them to resolve weak contrast objects, especially in the reflectance-mode imaging. Here we propose a method to spatially isolate illumination pathways from detection channels, and demonstrate wide-field reflectance imaging free from back-reflection noise. In the image fiber bundle, we send illumination light through individual core fibers and detect signals from target objects through the other fibers. The transmission matrix of the fiber bundle is measured and used to reconstruct a pixelation-free image. We demonstrated that the proposed imaging method improved 3.2 times on the signal to noise ratio produced by the conventional illumination-detection scheme. © 2017 The Author(s)

Novel Balloon Surface Scanning Device for Intraoperative Breast Endomicroscopy

Recent advances in fluorescence confocal endomicroscopy have allowed real-time identification of residual tumour cells on the walls of the cavity left by breast conserving surgery. However, it is difficult to systematically survey the surgical site because of the small imaging field-of-view of these probes, compounded by tissue deformation and inconsistent probe-tissue contact when operated manually. Therefore, a new robotized scanning device is required for controlled, large area scanning and mosaicing. This paper presents a robotic scanning probe with an inflatable balloon, providing stable cavity scanning over undulating surfaces. It has a compact design, with an outer diameter of 4 mm and a working channel of 2.2 mm, suitable for a leached flexible fibre bundle endomicroscope probe. With the probe inserted, the tip positioning accuracy measured to be 0.26 mm for bending and 0.17 mm for rotational motions. Large area scanning was achieved (25–35 mm2) and the experimental results demonstrate the potential clinical value of the device for intraoperative cavity tumour margin evaluation