Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

Abstract

AIM:To evaluate the feasibility and utility of confocal laser endomicroscopy (CLE) in the description of normal gastrointestinal (GI) mucosa and in the diagnosis of GI disorders in children, in comparison to histology. METHODS:Forty-four patients (19 female) median age 10.9 years (range 0.7-16.6 years) with suspected or known GI pathology underwent esophago-gastroduodenoscopy (OGD) (n = 36) and/or ileocolonoscopy (IC) (n = 31) with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively. RESULTS:Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min (range 7-25 min) for OGD and 27.9 min (range 15-45 min) for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures. Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease.CONCLUSION: CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.

Prospective evaluation of the utility of intraoperative confocal laser endomicroscopy in patients with brain neoplasms using fluorescein sodium: experience with 74 cases

“…2,19 This benefit was validated in its application to gastrointestinal and gynecological surgery. 5,[15][16][17][18] We have investigated the feasibility of CLE in a murine malignant glioma model to distinguish normal brain, microvasculature, and tumor margins. 4,8,9,14 Furthermore, we have demonstrated its potential application as an intraoperative tool in human brain tumor surgery.…”

The potential role of optical biopsy in the study and diagnosis of environmental enteric dysfunction

“…3d,e) when using intravenous fluorescein as a contrast agent. Other studies have shown that endomicroscopy can diagnose coeliac disease [55][56][57][58] based on recognition of features relevant to EED, such as villous atrophy, crypt hyperplasia and lymphocyte infiltration. In particular, Venkatesh et al 58 reported successful diagnosis of coeliac disease (100% sensitivity, 80% specificity) in children as young as 1.8 years of age.…”

“…Other studies have shown that endomicroscopy can diagnose coeliac disease [55][56][57][58] based on recognition of features relevant to EED, such as villous atrophy, crypt hyperplasia and lymphocyte infiltration. In particular, Venkatesh et al 58 reported successful diagnosis of coeliac disease (100% sensitivity, 80% specificity) in children as young as 1.8 years of age. Semi-automated methods for the detection and segmentation of villi 56 and for the measurement of goblet cell density 57 have also been presented.…”

Rigid Confocal Endoscopy of the Larynx

“…However, the penetration depth of LSM is limited due to two factors: background due to out-of-focus scattering and signal-to-noise ratio (Schmitt et al, 1997). Recently, a confocal microscope has been miniaturized and integrated into a conventional flexible endoscope (Venkatesh et al, 2009). The diameter of the distal tip of the endoscope is 12.8 mm including the integrated miniaturized confocal microscope with a diameter of 5 mm (Venkatesh et al, 2009).…”

“…Recently, a confocal microscope has been miniaturized and integrated into a conventional flexible endoscope (Venkatesh et al, 2009). The diameter of the distal tip of the endoscope is 12.8 mm including the integrated miniaturized confocal microscope with a diameter of 5 mm (Venkatesh et al, 2009). The use of endoscopes with this large diameter has so far been limited to the gastrointestinal tract.…”