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

Karstensen, John Gásdal; Săftoiu, Adrian; Brynskov, Jørn; Hendel, Jakob; Ciocalteu, Adriana; Klausen, Pia; Klausen, Tobias Wirenfeldt; Riis, Lene; Vilmann, Peter

doi:10.1016/j.gie.2016.01.069

Cited by 40 publications

(33 citation statements)

References 31 publications

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“…A contact microscope for optical biopsy sampling (confocal laser endomicroscope; Pentax Medical) has been proven promising in the real-time assessment of inflammatory severity in patients with UC. 9,26,27 However, it is a time-consuming and high-cost approach. EC is another technique for contact microscopy for optical biopsy sampling, and it has been used to evaluate the severity of inflammation and predict exacerbation in patients with UC.…”

Section: Discussionmentioning

confidence: 99%

Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

Maeda

Kudo

Mori

et al. 2019

Gastrointestinal Endoscopy

183

128

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Background and Aims: In the treatment of ulcerative colitis (UC), an incremental benefit of achieving histologic healing beyond that of endoscopic mucosal healing has been suggested; persistent histologic inflammation increases the risk of exacerbation and dysplasia. However, identification of persistent histologic inflammation is extremely difficult using conventional endoscopy. Furthermore, the reproducibility of endoscopic disease activity is poor. We developed and evaluated a computer-aided diagnosis (CAD) system to predict persistent histologic inflammation using endocytoscopy (EC; 520-fold ultra-magnifying endoscope). Methods: We evaluated the accuracy of the CAD system using test image sets. First, we retrospectively reviewed the data of 187 patients with UC from whom biopsy samples were obtained after endocytoscopic observation. EC images and biopsy samples of each patient were collected from 6 colorectal segments: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. All EC images were tagged with reference to the biopsy sample's histologic activity. For validation samples, 525 validation sets of 525 independent segments were collected from 100 patients, and 12,900 EC images from the remaining 87 patients were used for machine learning to construct CAD. The primary outcome measure was the diagnostic ability of CAD to predict persistent histologic inflammation. Its reproducibility for all test images was also assessed.

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Section: Discussionmentioning

confidence: 99%

Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

Maeda

Kudo

Mori

et al. 2019

Gastrointestinal Endoscopy

183

128

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“…In another study, in patients with Crohn's disease (CD) in endoscopic remission, fluorescein leakage proved to be a useful predictor for relapse of CD [23]. So far, no similar follow up has been reported for UC patients, although Karstensen et al did observe fluorescein leakage in 82% of patients with active UC [24]. As such, the data support that an intact mucosal barrier function is likely to be a reasonable target-to-treat, and that endoscopic confocal laser endomicroscopy has the potential of being part of the assessment toolbox, together with endoscopy and molecular signatures, of MH, disease activity and response to therapy.…”

Section: Mucosal Barrier Functionmentioning

confidence: 98%

Altered Structural Expression and Enzymatic Activity Parameters in Quiescent Ulcerative Colitis: Are These Potential Normalization Criteria?

Kjærgaard

Damm

Chang

et al. 2020

IJMS

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Mucosal healing determined by endoscopy is currently the remission standard for ulcerative colitis (UC). However, new criteria for remission are emerging, such as histologic normalization, which appears to correlate better to the risk of relapse. Here, we study mucosal healing on a molecular and functional level in quiescent UC. We obtained endoscopic biopsies from 33 quiescent UC patients and from 17 controls. Histology was assessed using Geboes score. Protein and mRNA levels were evaluated for the tight junction proteins claudin-2, claudin-4, occludin, and tricellulin, as well as Cl−/HCO3− exchanger DRA, and cyclo-oxygenase enzymes (COX-1, COX-2). The mucosal activity of COX-1 and COX-2 enzymes was assessed in modified Ussing chambers, measuring electrogenic ion transport (short-circuit current, SCC). Chronic inflammation was present in most UC patients. The protein level of claudin-4 was reduced, while mRNA-levels of claudin-2 and claudin-4 were upregulated in UC patients. Surprisingly, the mRNA level of COX-1 was downregulated, but was unaltered for COX-2. Basal ion transport was not affected, while COX-2 inhibition induced a two-fold larger decrease in SCC in UC patients. Despite being in clinical and endoscopic remission, quiescent UC patients demonstrated abnormal mucosal barrier properties at the molecular and functional level. Further exploration of mucosal molecular signature for revision of current remission standards should be considered.

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“…The reproducibility of luminal CLE parameters has been extensively studied for Barrett’s esophagus, IBD and colorectal polyps. In general, the results have been suitable for a clinical setting with acceptable inter- and intra-observer values 26 27 28 29 30 31 . Recently, the nCLE criteria for pancreatic cystic neoplasms have been evaluated.…”

Section: Discussionmentioning

confidence: 86%

Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses – a prospective validation study

et al. 2018

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Background and study aims Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a keystone in diagnosing and staging of pancreatic masses. Recently, a microfiber that can pass through a 19-gauge needle has been introduced for confocal laser endomicroscopy (nCLE). The aims of this study were to evaluate the diagnostic value and the reproducibility of nCLE criteria for solid malignant lesions. Patients and methods This prospective dual-center study included patients with pancreatic masses suspicious of malignancy referred for EUS-FNA. Endomicroscopic imaging was performed under EUS-guidance until organ-specific structures were obtained. Afterwards, standard cytology was obtained and patients were followed for up to 12 months. All nCLE parameters included in former studies were correlated with the final diagnosis (dark lobular structures/normal acinar cells, dark cell aggregates > 40 µm, dilated irregular vessels with fluorescein leakage, fine white fibrous bands, small black cell movements, pseudoglandular structures). Finally, three CLE novices and three CLE experts assessed the unedited movies from all patients. Results Twenty-eight patients were enrolled in the study. A final diagnosis was obtained in 24 patients (86 %). One patient (3 %) died before a diagnosis was obtained, while 3 were lost to follow-up (11 %). In 18/24 patients (74 %) the diagnosis was malignant. The mean sensitivity, specificity, and accuracy for the nCLE parameters ranged from 19 – 93 %, 0 – 56 %, 26 – 69 %, respectively. The inter-observer values ranged from κ = 0.20 – 0.41 for novices and κ = –0.02 – 0.38 for experts. Conclusions The diagnostic value of nCLE in solid pancreatic masses is questionable and the inter-observer agreement for both novices and CLE experts appears limited.

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

Cited by 40 publications

References 31 publications

Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

Fully automated diagnostic system with artificial intelligence using endocytoscopy to identify the presence of histologic inflammation associated with ulcerative colitis (with video)

Altered Structural Expression and Enzymatic Activity Parameters in Quiescent Ulcerative Colitis: Are These Potential Normalization Criteria?

Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses – a prospective validation study

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