Confocal laser endomicroscopy: a novel method for prediction of relapse in Crohn's disease

TY - JOUR

T1 - Confocal laser endomicroscopy

T2 - a novel method for prediction of relapse in Crohn's disease

AU - Karstensen, John Gásdal

AU - Săftoiu, Adrian

AU - Brynskov, Jørn

AU - Hendel, Jakob

AU - Klausen, Pia

AU - Cârtână, Tatiana

AU - Klausen, Tobias Wirenfeldt

AU - Riis, Lene Buhl

AU - Vilmann, Peter

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background and study aims: Confocal laser endomicroscopy (CLE) has been shown to predict relapse in ulcerative colitis in remission, but little is currently known about its role in Crohn's disease. The aim of this study was to identify reproducible CLE features in patients with Crohn's disease and to examine whether these are risk factors for relapse. Patients and methods: This was a single-center prospective feasibility study of CLE imaging in patients with Crohn's disease. CLE imaging was performed in the terminal ileum and four colorectal sites, and was correlated with histopathology and macroscopic appearance. Clinical relapse, defined as the need for treatment escalation or surgical intervention, was recorded during follow-up. Results: The study included 50 patients: 39 with Crohn's disease (20 in remission), and 11 controls. Ileal fluorescein leakage and microerosions were significantly more frequent in patients with endoscopically active Crohn's disease compared with patients with inactive Crohn's disease and controls (P = 0.005 and (P = 0.006, respectively). The same applied to colorectal fluorescein leakage and vascular alterations ((P = 0.043 and (P = 0.034, respectively). During a 12-month follow-up period, ileal fluorescein leakage and microerosions were significant risk factors for relapse in the subgroup of patients in remission (log rank (P = 0.009 and (P = 0.007, respectively) as well as in the entire group of patients with Crohn's disease (log rank (P = 0.006 and (P = 0.01, respectively). Inter- and intraobserver reproducibility was almost perfect (κ > 0.80) or substantial (κ > 0.60) for the majority of CLE parameters. Conclusions: CLE can identify reproducible microscopic changes in the terminal ileum that are risk factors for relapse in patients with otherwise inactive Crohn's disease.

AB - Background and study aims: Confocal laser endomicroscopy (CLE) has been shown to predict relapse in ulcerative colitis in remission, but little is currently known about its role in Crohn's disease. The aim of this study was to identify reproducible CLE features in patients with Crohn's disease and to examine whether these are risk factors for relapse. Patients and methods: This was a single-center prospective feasibility study of CLE imaging in patients with Crohn's disease. CLE imaging was performed in the terminal ileum and four colorectal sites, and was correlated with histopathology and macroscopic appearance. Clinical relapse, defined as the need for treatment escalation or surgical intervention, was recorded during follow-up. Results: The study included 50 patients: 39 with Crohn's disease (20 in remission), and 11 controls. Ileal fluorescein leakage and microerosions were significantly more frequent in patients with endoscopically active Crohn's disease compared with patients with inactive Crohn's disease and controls (P = 0.005 and (P = 0.006, respectively). The same applied to colorectal fluorescein leakage and vascular alterations ((P = 0.043 and (P = 0.034, respectively). During a 12-month follow-up period, ileal fluorescein leakage and microerosions were significant risk factors for relapse in the subgroup of patients in remission (log rank (P = 0.009 and (P = 0.007, respectively) as well as in the entire group of patients with Crohn's disease (log rank (P = 0.006 and (P = 0.01, respectively). Inter- and intraobserver reproducibility was almost perfect (κ > 0.80) or substantial (κ > 0.60) for the majority of CLE parameters. Conclusions: CLE can identify reproducible microscopic changes in the terminal ileum that are risk factors for relapse in patients with otherwise inactive Crohn's disease.

KW - Adult

KW - Aged

KW - Colon

KW - Colonoscopy

KW - Crohn Disease

KW - Feasibility Studies

KW - Female

KW - Fluorescein

KW - Fluorescent Dyes

KW - Humans

KW - Ileum

KW - Intestinal Mucosa

KW - Male

KW - Microscopy, Confocal

KW - Middle Aged

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Rectum

KW - Recurrence

KW - Reproducibility of Results

KW - Risk Factors

KW - Journal Article

KW - Randomized Controlled Trial

KW - Research Support, Non-U.S. Gov't

U2 - 10.1055/s-0034-1393314

DO - 10.1055/s-0034-1393314

M3 - Journal article

C2 - 26583952

SN - 0013-726X

VL - 48

SP - 364

EP - 372

JO - Endoscopy

JF - Endoscopy

IS - 4

ER -