Over the past two decades, the bulk of gastrointestinal (GI) endoscopic procedures has shifted away from diagnostic and therapeutic interventions for symptomatic disease toward cancer prevention in asymptomatic patients. This shift has resulted largely from a decrease in the incidence of peptic ulcer disease in the era of antisecretory medications coupled with emerging evidence for the efficacy of endoscopic detection and eradication of dysplasia, a histopathological biomarker widely accepted as a precursor to cancer. This shift has been accompanied by a drive toward minimally invasive, in situ optical diagnostic technologies that help to assess the mucosa for cellular changes that relate to dysplasia. Two competing but complementary approaches have been pursued. The first approach is based on broad-view targeting of “areas of interest” or “red flags”. These broad-view technologies include standard white light endoscopy (WLE), high-definition endoscopy (HD), and “electronic” chromoendoscopy (narrow-band-type imaging). The second approach is based on multiple small area or point-source (meso/micro) measurements, which can be either machine (spectroscopy) or human-interpreted (endomicroscopy, magnification endoscopy), much as histopatholgy slides are. In this paper we present our experience with the development and testing of a set of familiar but “smarter” standard tissue-sampling tools that can be routinely employed during screening/surveillance endoscopy. These tools have been designed to incorporate fiberoptic probes that can mediate spectroscopy or endomicroscopy. We demonstrate the value of such tools by assessing their preliminary performance from several ongoing clinical studies. Our results have shown promise for a new generation of integrated optical tools for a variety of screening/surveillance applications during GI endoscopy. Integrated devices should prove invaluable for dysplasia surveillance strategies that currently result in large numbers of benign biopsies, which are of little clinical consequence, including screening for colorectal polyps and surveillance of “flat” dysplasia such as Barrett’s esophagus and chronic colitis due to inflammatory bowel diseases.

在过去的二十年里，大部分胃肠 (GI) 内窥镜手术已经从对有症状疾病的诊断和治疗干预转向无症状患者的癌症预防。这种转变主要是由于抗分泌药物时代消化性溃疡病的发病率下降，再加上内窥镜检测和根除异型增生（一种被广泛接受为癌症前兆的组织病理学生物标志物）有效性的新证据。这种转变伴随着对微创、原位有助于评估与发育不良相关的细胞变化的粘膜的光学诊断技术。已经采用了两种相互竞争但互补的方法。第一种方法基于对“感兴趣的领域”或“危险信号”的广泛定位。这些宽视野技术包括标准白光内窥镜 (WLE)、高清内窥镜 (HD) 和“电子”彩色内窥镜（窄带型成像）。第二种方法基于多个小区域或点源（中观/微观）测量，可以是机器（光谱）或人工解释（内窥镜检查、放大内窥镜检查），就像组织病理学载玻片一样。在本文中，我们介绍了我们在开发和测试一组熟悉但“更智能”的标准组织取样工具方面的经验，这些工具可以在筛查/监测内窥镜检查中常规使用。这些工具被设计成结合可以调节光谱学或内窥镜检查的光纤探针。我们通过评估几项正在进行的临床研究的初步性能来证明这些工具的价值。我们的研究结果表明，新一代集成光学工具有望在 GI 内窥镜检查期间用于各种筛查/监测应用。集成设备对于目前导致大量良性活检的不典型增生监测策略应该证明是无价的，这些活检几乎没有临床后果，