"The present is theirs; the future, for which I really worked,...

"The present is theirs; the future, for which I really worked, is mine."

Nikola Tesla

My friends,

It takes a lot to get to get old Tiresias excited. This week he is just too excited to even concentrate on his usual contemplations. You see my friends, for some time now Tiresias has known, but not studied, of a new technique developing for treatment of early malignancy of the gastrointestinal tract, predominately cancer of the stomach and the colon. Recently, out of coincidences or fate, he cause to look deeper into this. What Tiresias sees, and what he sees for the future of Optiscan Confocal Laser Endomicroscopy is nothing short of stunning.

You see my friends, to start slowly, gastrointestinal malignancy, predominantly and stomach and colon cancer, but also cancer of the oesophagus and rectum, together, is leading cause of death around the world. In the developed world, there are huge screening programs, such as testing for occult faecal blood and routine endoscopy. These however are limited, and most importantly miss the earliest signs of cancer, when cancer treatment could be easily curative. G-I cancer, when now detected, is often advanced and has often spread both by local infiltration, or distally, by metastasis. Treatment then is radical; either colectomy (removal of the colon), gastrectomy (removal of the stomach), oesophagectomy, (a surgery one would not wish on their worst enemy), and the rest. Then the rest; chemotherapy and constant endoscopic screening, flawed as it is, and PET and other scanning.

But now, the reason for Tiresias’s excitement. There is something new around. A new technique, out of Japan: Endoscopic Submucosal dissection (ESD). This is used when cancer is detected in-situ, ie a local cancer spot of the mucosa (the lining layer of the G-I tract where cancer arises), which hasn't yet spread beyond the mucosa, and which can be respected via the endoscope, not requiring any major surgery. Though Tiresias has been aware of this technique for some time, the reasons it has remained relatively obscure and limited are severalfold. First; the cancer is not often detected early enough because the current screening, which does not use in-vivo cell level microscopy cannot detect most of the early cancer to enable endoscopic treatment. This is the first application for Optiscan’s CLE; to microscopically examine suspicious lesions and detect cancer before it is too late. Second; ESD is currently reliant on inadequate techniques for visualizing the cancer and determining the staging of the lesion. At present, this includes endoscopic magnification techniques which are 1/10 to 1/20 the magnification of Optiscan’s Confocal Laser Endomicroscopy and cannot visualise the necessary cellular level histopathological to clearly show the exact extent and margins of the malignant cells, and if any are left behind after the procedure. So, for ESD to become standard of care, and in Tiresias’s opinion greatly improve patient outcomes and greatly reduced morbidity to the patient, Optiscan’s in-vivo, cellular level endomicroscopy, both in the screening and in the endoscopic microsurgery itself will transform screening and treatment of gastrointestinal cancer; the leading cause of cancer death in the world.

But my friends, as they say in late night TV knife advertisements, that’s not all. You, my friends, who like Tiresias, have been in Optiscan for a long time, recall that Optiscan has already produced a flexible Endomicroscope which can be used through endoscopes. My friends of course recall Optiscan’s previous partnering with Pentax, the Japanese endoscope manufacturer. Tiresias may not need to remind some that this Optiscan Endomicroscope has FDA Approval and has CE Mark. These, that is FDA Approval and CE Mark are still valid. Pentax, taken over by Hoya, long post GFC, is still in business. Tiresias is sure this has not escaped the notice of the new management!

The past is theirs, but the future, for which we have waited, is indeed ours.