Wide-field flexible endoscope for simultaneous color and NIR fluorescence image acquisition during surveillance colonoscopy

Colorectal cancer (CRC) is the third most common form of cancer and, despite recent declines in both incidence and mortality, it still remains the second leading cause of cancer-related deaths in the western world. Colonoscopy is the standard for detection and removal of premalignant lesions to prevent CRC. The major challenges that physicians face during surveillance colonoscopy are the high adenoma miss-rates and the lack of functional information to facilitate decision-making concerning which lesions to remove. Targeted imaging with NIR fluorescence would address these limitations. Tissue penetration is increased in the NIR range while the combination with targeted NIR fluorescent agents provides molecularly specific detection of cancer cells, i.e. a red-flag detection strategy that allows tumor imaging with optimal sensitivity and specificity. The development of a flexible endoscopic fluorescence imaging method that can be integrated with standard medical endoscopes and facilitates the clinical use of this potential is described in this work. A semi-disposable coherent fiber optic imaging bundle that is traditionally employed in the exploration of biliary and pancreatic ducts is proposed, since it is long and thin enough to be guided through the working channel of a traditional video colonoscope allowing visualization of proximal lesions in the colon. A custom developed zoom system magnifies the image of the proximal end of the imaging bundle to fill the dimensions of two cameras operating in parallel providing the simultaneous color and fluorescence video acquisition.