Confocal laser endomicroscopy in ulcerative colitis: a longitudinal study of endomicroscopic changes and response to medical therapy (with videos)

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• 作者：John Gá ; sdal Karstensen ; MD ; PhD¹ ; ; Adrian Săftoiu ; MD ; PhD ; MS ; FASGE¹ ; ² ; Jø ; rn Brynskov ; MD ; DMSc¹ ; Jakob Hendel ; MD ; PhD¹ ; Adriana Ciocalteu ; MD¹ ; ² ; Pia Klausen ; MSc ; PhD¹ ; Tobias Wirenfeldt Klausen ; MSc³ ; Lene Buhl Riis ; MD ; PhD⁴ ; Peter Vilmann ; MD ; DMSc ; HC ; FASGE¹
• 关键词：CLE ; confocal laser endomicroscopy ; eCLE ; endoscope-based confocal laser endomicroscopy ; IBD ; inflammatory bowel disease ; pCLE ; probe-based confocal laser endomicroscopy
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：84
• 期：2
• 页码：279-286.e1
• 全文大小：947 K

文摘

Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment.

Methods

Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were enrolled. The colonic mucosa was examined with high-definition colonoscopy, histopathology, and CLE at 4 colonic sites. Subsequently, patients requiring medical treatment escalation were referred for repeat endoscopy with CLE after 6 to 8 weeks.

Results

The baseline frequency of fluorescein leakage (P < .001), microerosions (P < .001), tortuosity of the crypts (P = .001), distortion of the crypts openings (P = .001), presence of inflammatory infiltrates (P < .001), and decreased crypt density (P < .001) were significantly higher in active ulcerative colitis compared with inactive ulcerative colitis and control subjects. A decrease in histopathologic score after medical treatment escalation was correlated with improvement in crypt tortuosity (r_s = .35, P = .016), distortion of crypt openings (r_s = .30, P = .045), and decreased crypt density (r_s = .33, P = .026) but not in other features.

Conclusions

CLE is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. (Clinical trial registration number: NCT01684514.)