Confocal endomicroscopy is a new imaging technique that enables the structure of a tissue or organ, whether healthy or pathological, to be visualized dynamically and in real time, at the cellular level. The conference will consider the applications of endomicroscopy in digestive pathology. Digestive cancers, and in particular colorectal cancers, represent a major public health issue due to their frequency (over 35,000 new cases and 17,000 deaths every year in France). Colorectal cancers, like esophageal cancers, most often develop on a precancerous lesion (adenomatous polyp in the first case, endobrachyoesophagus in the second). Advances in diagnostic and therapeutic endoscopy have made it possible not only to diagnose pre-cancerous lesions at an earlier stage, but also to recognize them and remove them (by endoscopic excision or in situ destruction) using methods far less invasive than surgery. The removal of these precancerous lesions thus ensures genuine prevention, the only guarantee of preserved life expectancy and quality of life.
Unfortunately, current techniques still come up against a number of limitations: (i) insufficient diagnostic sensitivity, (i) insufficient diagnostic sensitivity, e.g. in the case of biliary tract cancers (ii) need for multiple samples (biopsies) to be sent to the pathological anatomy laboratory for subsequent histological analysis (iii) need for repeated endoscopic examinations and biopsies random biopsies when precancerous lesions (dysplasia of various grades) are not visible to the naked eye with standard endoscopy (even high-definition endoscopy) (iv) lack of individualized therapeutic management depending on the nature of the lesion, for example, removal of all colonic polyps, even those with no potential for cancerous transformation. The same concern to develop a more personalized form of medicine can be seen in chronic inflammatory bowel diseases (Crohn's disease and ulcerative colitis), which have benefited from major therapeutic advances (anti-TNF antibodies) over the past decade, but which do not always justify the use of costly and cumbersome biological therapies.
