In vivo characterization of abnormalities in small-bowel diseases using probe-based confocal laser endomicroscopy

Abstract

Background and study aims Probe-based confocal laser endomicroscopy (pCLE) enables real-time optical biopsy. Little is known about pCLE imaging deep inside the small bowel, therefore the aim of this study was to determine its usefulness. Patients and methods Between April 2014 and January 2016, we performed 38 pCLE examinations during double-balloon enteroscopy with intravenous fluorescein in 37 patients with: tumors (n = 10), vascular disorders (n = 6), inflammatory diseases and drug injuries (n = 13), other disorders (n = 4), and normal findings (n = 4). We measured the calibers of capillary and lymphatic vessels at 15 different sites and compared the calibers between pCLE images and histopathology. We also compared pCLE findings with pathologic diagnosis. Results The inner diameters of capillary vessels beneath the epithelium and in the middle of villi were 16.2 ± 3.0 µm and 14.5 ± 3.1 µm, respectively, in the pCLE images, but these were not consistent with formalin-fixed paraffin-embedded histology. In tumors, larger capillary vessels were observed in aggressive malignant lymphoma and metastasis, and a “soccer ball-like pattern” constituting homogenous dark cells packed with polygonal, narrower capillary vessels was characteristic in pCLE images of a malignant lymphoma follicle. Hereditary hemorrhagic telangiectasia and angiodysplasia contained anastomosis of capillary vessels of different calibers. In IgA vasculitis, segmental capillary strictures were observed. Intestinal lymphangiectasia with protein-losing enteropathy contained a reticular network of lymphatic vessels and dilated lymphatic ducts accompanied by numerous cell gaps. pCLE findings corresponded to pathologic diagnosis in 32 examinations (91 %). Conclusions pCLE is useful for in vivo analysis of abnormalities of the capillary and lymphatic vessels and epithelium, and for diagnosis in various small-bowel diseases.

Endoscopic ultrasound‐guided needle‐based confocal laser endomicroscopy in gastrointestinal subepithelial lesions: Feasibility study

“…The present study showed that dark pleomorphic nests and disorganized irregular‐shaped dark glands were observed in patients with rectal metastasis from lung adenocarcinoma and SEL‐like extremely well‐differentiated gastric adenocarcinoma, respectively. We also reported that probe‐based CLE showed irregular dark nests in jejunal metastasis from cervical cancer, disorganized irregular dark glands in early‐stage gastric cancer covered by nontumorous regenerative epithelium or maturated atypical glands found after Helicobacter pylori eradication, and back‐to‐back orientation of dark crypts in ulcerative colitis‐associated differentiated adenocarcinoma and dark trabecular architecture in ulcerative colitis‐associated undifferentiated adenocarcinoma . The Miami classification system based on a consensus of probe‐based CLE users to standardize categorization of images indicated that all cancers in the esophagus, stomach, colorectum, and biliary duct were characterized by disorganized structures of dark (“nonrefractile”) epithelium or cells .…”

“…nCLE examinations were carried out between 40 s and 20 min after i.v. injection of 250 mg fluorescein (100 mg/mL, Fluorescite; Novartis Pharma K.K., Tokyo, Japan) as described previously . For EUS‐FNA, the needle was moved back and forth 20 times within the lesion keeping away from necrosis, if any, while suction was applied using a 20‐mL syringe.…”

“…injection of 250 mg fluorescein (100 mg/mL, Fluorescite; Novartis Pharma K.K., Tokyo, Japan) as described previously. 15,16 For EUS-FNA, the needle was moved back and forth 20 times within the lesion keeping away from necrosis, if any, while suction was applied using a 20-mL syringe. The needle was passed repeatedly until sufficient tissue acquisition for macroscopic on-site quality evaluation but without ROSE.…”

Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications

“…A study of 38 pCLE examinations performed during a double-balloon enteroscopy, identified characteristic pCLE features of various small-bowel diseases based on the size of the capillary calibres and lymphatic vessels. CLE pathological features correctly correlated with histopathologic diagnosis in 91% cases (31).…”

Jejunal GI tumor using probe-based confocal laser endomicroscopy

“…The pCLE benefits patients who are taking antithrombotic agents, who have bleeding tendencies, or who have a condition for which taking pathologic samples is contraindicated or not recommended. 2 Even if regenerating nontumorous epithelium overlies the tumorous tissue, pCLE may be able to detect it by visualization of the subsurface microscopic architecture less than 100 μm in depth. 3 In conclusion, pCLE could help in the in vivo diagnosis of submucosal hypervascular tumors such as GIST in cases in which biopsy is not recommended.…”