Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

Abstract

The development of probe-based confocal laser endomicroscopy (pCLE) has allowed endoscopists to observe gastrointestinal (GI) lesions with thousand-fold magnification and real time in vivo histologic evaluation of the lesions. 1 Several prior studies have already shown the usefulness and safety of optical biopsy using pCLE in the field of gastroenterology 2-5 and it has further been reported that pCLE is relatively easy to learn. 6,7 Intravenous (IV) fluorescein is an essential contrast agent required to obtain clear images with pCLE. Although rare, severe adverse reactions to IV fluorescein, that may lead to life-threatening conditions, 8-10 have been reported. Furthermore, the incidence of nausea and vomiting after IV administration of fluorescein has been reported to be as high as around 6% for nausea and 1% for vomiting. 11-13 Ethnic variation has also reported for fluorescein induced nausea and vomiting, with a higher risk of occurrence in Asian individuals compared to Caucasian individuals. 14 Moreover, a dose-dependent adverse reactions response for IV or intrathecally ad

Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy

“…Moreover, the intravenous fluorescein administration (dose 4–8 mg/kg) can lead to adverse reactions, including nausea, vomiting, and rash at the injection site, in more than 1% of cases 98 . Recently, Inoki et al 99 . revealed that by reducing the dose of fluorescein to 0.5 mg/kg, tissue structure visualization of all colorectal neoplasias remained optimal (12/12 lesions, 100%), with no serious adverse reactions.…”