Tekinologiya w’abaddugavu mu by’obujjanjabi (5) Confocal Laser Microendoscopy (CLE) .

Confocal Laser Endoscopy (CLE) ye tekinologiya eyamenyewo "in vivo pathology" mu myaka egiyise, asobola okutuuka ku kukuba ebifaananyi mu kiseera ekituufu eby'obutoffaali ku kukula emirundi 1000 mu kiseera ky'okukebera endoscopic, okukyusa enkola ey'ekinnansi ey'okuzuula "biopsy first → pathology later". Wansi waliwo okwekenneenya okw’amaanyi okwa tekinologiya ono ow’omulembe okuva mu bipimo 8:

1.Emisingi gy’ebyekikugu n’enzimba y’enkola

Enkola y’okukuba ebifaananyi enkulu:

Enkola ya confocal optics: Ekitangaala kya layisi kitunuulirwa ku buziba obw’enjawulo (0-250 μ m), nga kifuna ekitangaala kyokka ekitunuuliddwa okuva mu nnyonyi etunuuliddwa era ne kimalawo okutaataaganyizibwa kw’okusaasaana

Okukuba ebifaananyi mu ngeri ya fluorescence: kyetaagisa okukuba empiso mu misuwa/okufuuyira mu kitundu ebirungo ebitangaaza (nga sodium fluorescein, acridine yellow) .

Enkola ya sikaani:

Okusika ensonga (eCLE): Okusika ensonga ku nsonga, okusalawo kwa waggulu (0.7 μ m) naye nga ku sipiidi ya mpola

Okusika ku ngulu (pCLE): Okusika mu ngeri ey’okukwatagana, omutindo gwa fuleemu ogw’amangu (12fps) okusobola okwetegereza okw’amaanyi

Ebitonde by’enkola:

Laser Generator (488nm Layisi ya Bbululu eya bulijjo)

Micro confocal probe (nga erina obuwanvu obutono obwa mm 1.4 eyinza okuyingizibwa okuyita mu mikutu gya biopsy)

Ekitundu ekikola ku bifaananyi (okukendeeza ku maloboozi mu kiseera ekituufu+okuzimba okuddamu okuzimba mu 3D)

AI assisted analysis module (nga okuzuula otomatiki obutaba bwa goblet cell) .

2. Enkizo mu kumenyawo tekinologiya

3. Ensonga z’okukozesa mu bujjanjabi

Ebikulu ebiraga nti:

Kookolo w’enkola y’okugaaya emmere nga bukyali:

Kookolo w’olubuto: okusosola mu kiseera ekituufu ku metaplasia/dysplasia y’ekyenda (omuwendo gw’obutuufu 91%) .

Kookolo w’olubuto n’omumwa gwa nnabaana: ensengeka y’ebisenge by’emikutu gy’endwadde (glandular duct classification) .

Endwadde z’ekibumba n’olubuto:

Okuzuula enjawulo mu kuzimba kw’omukutu gw’entuuyo okutali kwa bulabe n’okuzibu (sensitivity 89%) .

Okukuba ebifaananyi by’ekisenge eky’omunda eky’ekizimba ky’olubuto (okwawula ebika bya IPMN) .

Enkozesa y’okunoonyereza:

Okukebera obulungi bw’eddagala (nga okulondoola mu ngeri ey’amaanyi okuddaabiriza omusulo gw’obulwadde bwa Crohn) .

Okunoonyereza ku microbiome (okutunuulira ensaasaanya y’ebifo ebitonotono eby’omu byenda) .

Embeera z’emirimu eza bulijjo:

(1) Empiso ya fluorescein sodium mu misuwa (10% 5ml) .

(2) Confocal probe ekwatagana ne mucosa eteeberezebwa

(3) Okwetegereza mu kiseera ekituufu ensengekera y’endwadde/enkula ya nyukiliya

(4) Okusalawo okuyambibwako AI ku Pit classification oba Vienna grading

4. Okukiikirira abakola ebintu n’ebipimo by’ebintu

5. Okusoomoozebwa okw’ekikugu n’okugonjoola ebizibu

Ebizibu ebiriwo:

Enkola y’okuyiga eri waggulu: okukuguka mu kiseera kye kimu mu kukebera endoscopy n’okumanya pathology kyetaagisa (ekiseera ky’okutendekebwa>emyezi 6)

Ekigonjoolwa: Okukola maapu z’okuzuula CLE ezituukiridde (nga okugabanya kwa Mainz) .

Ebintu ebikozesebwa mu kutambula: Ebikosa okussa/peristaltic bikosa omutindo gw’ebifaananyi

Ekigonjoola: Eriko enkola y’okuliyirira enkyukakyuka (dynamic compensation algorithm).

Okukoma ku kirungo kya fluorescent: Sodium fluorescein tesobola kulaga bikwata ku nyukiliya y’obutoffaali

Obulagirizi bw’okumenya: Ebikebera molekyu ebigendereddwamu (nga anti EGFR fluorescent antibodies) .

Obukugu mu kukola emirimu:

Tekinologiya wa Z-axis scanning: okwetegereza ensengeka ya buli layeri ya mucosa mu layeri

Enkola ya virtual biopsy: okussaako akabonero ku bitundu ebitali bya bulijjo n’oluvannyuma okutwala sampuli mu butuufu

6. Enkulaakulana mu kunoonyereza okusembyeyo

Okumenyawo ensalo mu mwaka gwa 2023-2024:

Okwekenenya mu bungi bwa AI:

Ttiimu ya Harvard ekola enkola y’okuteeba obubonero mu bifaananyi bya CLE (Gastroenterology 2023)

Okumanya okuyiga okw’amaanyi okw’obungi bw’obutoffaali bwa goblet (obutuufu 96%) .

Okuyungibwa kwa obutangaavu obungi:

Ttiimu ya Girimaani etegeera CLE+second harmonic imaging (SHG) okugatta okwetegereza ensengekera ya kolagini

Nano probe:

Chinese Academy of Sciences ekola CD44 targeted quantum dot probe (naddala okuwandiika obutoffaali obusibuka mu kookolo w’olubuto)

Ebikulu ebikoleddwa mu kugezesebwa mu malwaliro:

Okunoonyereza kwa PRODIGY: CLE guided ESD surgical margin negative rate yalinnya okutuuka ku 98%

Okugezesebwa kwa CONFOCAL-II: obutuufu bw’okuzuula ebizimba by’olubuto ebitundu 22% okusinga EUS

7. Emitendera gy’enkulaakulana mu biseera eby’omu maaso

Enkulaakulana mu tekinologiya:

Super resolution breakthrough: STED-CLE etuuka ku<200nm okusalawo (okumpi ne obusannyalazo microscopy)

Okukuba ebifaananyi ebitaliiko kabonero: enkola eyesigamiziddwa ku kusaasaana kw’ekitangaala (spontaneous fluorescence/Raman scattering).

Obujjanjabi obugattibwa: probe ey’amagezi n’omulimu gw’okuggya layisi ogugatta

Okugaziya okukozesa mu bujjanjabi:

Okuteebereza obulungi bw’obujjanjabi bw’obusimu obuziyiza endwadde z’ekizimba (okwetegereza okuyingira kw’obutoffaali bwa T) .

Okukebera emirimu gy’ebizimba by’obusimu

Okulondoola amangu enkola y’okugaana ebitundu by’omubiri ebisimbibwa

8. Okwolesa emisango egya bulijjo

Omusango 1: Okulondoola omumwa gwa Barrett

Okuzuula CLE: obuzibu mu nsengeka y’ennywanto+okufiirwa polarity ya nukiriya

Okuzuula amangu: Obulwadde bwa Highly dysplasia (HGD) .

Obujjanjabi obugoberera: Obujjanjabi bwa EMR n’okukakasa obulwadde bwa HGD

Omusango 2: Obulwadde bw’olubuto obuva mu mabwa

Endoscopy ey’ekinnansi: okuzimba kw’omubiri n’okuzimba (tewali biwundu bikwekeddwa ebizuuliddwa) .

Okwolesebwa kwa CLE: okusaanyaawo enzimba ya crypt+okukulukuta kwa fluorescein

Okusalawo kw’obujjanjabi: Okulongoosa obujjanjabi bw’ebiramu

Mu bufunze n’endowooza

Tekinologiya wa CLE avuga okuzuula obulwadde mu endoscopic mu mulembe gwa "real-time pathology at the cellular level":

Ebbanga ettono (emyaka 1-3): Enkola eziyambibwako AI zikendeeza ku biziyiza okukozesa, omuwendo gw’okuyingira gusukka ebitundu 20%

Mid term (emyaka 3-5): Ebikebera molekyu bituuka ku kuwandiika ebizimba ebitongole

Ebbanga eddene (emyaka 5-10): kiyinza okudda mu kifo ky’ebitundu ebimu eby’okuzuula obulwadde

Tekinologiya ono ajja kwongera okuddamu okuwandiika enkola y’obusawo eya ‘ky’olaba kye ky’ozuula’, okukkakkana ng’atuuse ku kigendererwa ekisembayo ekya ‘in vivo molecular pathology’.