Karstensen John Gásdal, Săftoiu Adrian, Brynskov Jørn, Hendel Jakob, Ciocalteu Adriana, Klausen Pia, Klausen Tobias Wirenfeldt, Riis Lene Buhl, Vilmann Peter
Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
Gastrointest Endosc. 2016 Aug;84(2):279-286.e1. doi: 10.1016/j.gie.2016.01.069. Epub 2016 Mar 2.
Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment.
Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were enrolled. The colonic mucosa was examined with high-definition colonoscopy, histopathology, and CLE at 4 colonic sites. Subsequently, patients requiring medical treatment escalation were referred for repeat endoscopy with CLE after 6 to 8 weeks.
The baseline frequency of fluorescein leakage (P < .001), microerosions (P < .001), tortuosity of the crypts (P = .001), distortion of the crypts openings (P = .001), presence of inflammatory infiltrates (P < .001), and decreased crypt density (P < .001) were significantly higher in active ulcerative colitis compared with inactive ulcerative colitis and control subjects. A decrease in histopathologic score after medical treatment escalation was correlated with improvement in crypt tortuosity (rs = .35, P = .016), distortion of crypt openings (rs = .30, P = .045), and decreased crypt density (rs = .33, P = .026) but not in other features.
CLE is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. (
NCT01684514.).
共聚焦激光内镜显微镜检查可在内镜检查期间进行实时体内显微镜检查，并可预测炎症性肠病缓解期患者的复发情况。然而，关于内镜显微镜特征如何随时间变化，人们了解甚少。这项纵向研究的目的是将溃疡性结肠炎患者的结肠共聚焦激光内镜显微镜检查（CLE）结果与强化药物治疗前后的组织病理学及宏观表现进行关联分析。
纳入22例处于临床复发期的溃疡性结肠炎患者以及7例因结肠镜检查而转诊的对照受试者。在4个结肠部位采用高清结肠镜检查、组织病理学检查及CLE对结肠黏膜进行检查。随后，需要强化药物治疗的患者在6至8周后接受重复内镜检查及CLE检查。
与非活动性溃疡性结肠炎患者及对照受试者相比，活动性溃疡性结肠炎患者的荧光素渗漏（P <.001）、微糜烂（P <.001）、隐窝迂曲（P =.001）、隐窝开口变形（P =.001）、炎性浸润（P <.001）以及隐窝密度降低（P <.001）的基线频率显著更高。强化药物治疗后组织病理学评分的降低与隐窝迂曲改善（rs =.35，P =.016）、隐窝开口变形改善（rs =.30，P =.045）以及隐窝密度降低改善（rs =.33，P =.026）相关，但与其他特征无关。
CLE是一种新兴的内镜技术，可重复性地识别溃疡性结肠炎的黏膜变化。除隐窝变化外，内镜显微镜特征在药物治疗后似乎随时间缓慢改善。（临床试验注册号：NCT01684514。）
