TY - JOUR
T1 - Confocal laser endomicroscopy in ulcerative colitis
T2 - a longitudinal study of endomicroscopic changes and response to medical therapy (with videos)
AU - Karstensen, John Gásdal
AU - Săftoiu, Adrian
AU - Brynskov, Jørn
AU - Hendel, Jakob
AU - Ciocalteu, Adriana
AU - Klausen, Pia
AU - Klausen, Tobias Wirenfeldt
AU - Riis, Lene Buhl
AU - Vilmann, Peter
N1 - Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background and Aims 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 (rs =.35, P =.016), distortion of crypt openings (rs =.30, P =.045), and decreased crypt density (rs =.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.)
AB - Background and Aims 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 (rs =.35, P =.016), distortion of crypt openings (rs =.30, P =.045), and decreased crypt density (rs =.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.)
KW - Journal Article
U2 - 10.1016/j.gie.2016.01.069
DO - 10.1016/j.gie.2016.01.069
M3 - Journal article
C2 - 26945556
SN - 0016-5107
VL - 84
SP - 279-286.e1
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 2
ER -