Odagi Isao, Kato Tomohiro, Imazu Hiroo, Kaise Mitsuru, Omar Salem, Tajiri Hisao
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
J Gastroenterol Hepatol. 2007 May;22(5):658-62. doi: 10.1111/j.1440-1746.2007.04837.x.
Endoscopy is an important clinical tool for the diagnosis and treatment of gastrointestinal disorders. However, biopsy tissue is still required in many cases to obtain a definitive histopathological diagnosis. The aim of this study was to evaluate confocal endomicroscopy (CEM) as a tool for conducting virtual biopsies of the colon by comparing CEM images with biopsy samples from normal colon.
The study cohort comprised 45 patients who underwent investigative colonoscopy between April 2004 and January 2006, 25 of whom also had biopsy due to suspected diseases such as inflammation and neoplasm. The small and large intestine were examined with CEM using an intravenous injection of fluorescein, and CEM images were compared with conventional histopathological results from biopsied samples. In addition, the injected fluorescein was localized immunohistochemically to further analyze the CEM images taken in vivo.
A total of 46 biopsies were taken, of which 24 demonstrated no histopathological abnormality and were regarded as normal. All of the CEM images observed from the surface to the deeper layers were concordant histopathologically with the biopsy results. Furthermore, CEM allowed observation of physiological functions such as blood flow in the capillaries of the surrounding crypts and mucus release from crypts. The immunohistochemical localization of fluorescein was consistent with the CEM images.
CEM provides endoscopists with a valuable new diagnostic tool, not only for observing tissue in situ at the histopathological level, but also for the coincident evaluation of physiological function during endoscopic examination.
内镜检查是诊断和治疗胃肠道疾病的重要临床工具。然而，在许多情况下仍需要活检组织以获得明确的组织病理学诊断。本研究的目的是通过将共聚焦内镜显微镜（CEM）图像与正常结肠活检样本进行比较，评估CEM作为结肠虚拟活检工具的价值。
研究队列包括2004年4月至2006年1月期间接受结肠镜检查的45例患者，其中25例因怀疑有炎症和肿瘤等疾病也进行了活检。通过静脉注射荧光素，使用CEM对小肠和大肠进行检查，并将CEM图像与活检样本的传统组织病理学结果进行比较。此外，对注射的荧光素进行免疫组织化学定位，以进一步分析体内拍摄的CEM图像。
共进行了46次活检，其中24次未显示组织病理学异常，被视为正常。从表面到深层观察到的所有CEM图像在组织病理学上均与活检结果一致。此外，CEM能够观察到诸如周围隐窝毛细血管中的血流和隐窝黏液分泌等生理功能。荧光素的免疫组织化学定位与CEM图像一致。
CEM为内镜医师提供了一种有价值的新诊断工具，不仅可在组织病理学水平原位观察组织，还可在内镜检查期间同时评估生理功能。
