Inoki Kazuya, Abe Seiichiro, Tanaka Yusaku, Yamamoto Koji, Hihara Daisuke, Ichijima Ryoji, Nakatani Yukihiro, Chen Hsin-Yu, Takamaru Hiroyuki, Sekiguchi Masau, Yamada Masayoshi, Sakamoto Taku, Nonaka Satoru, Suzuki Haruhisa, Yoshinaga Shigetaka, Oda Ichiro, Matsuda Takahisa, Saito Yutaka
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Clin Endosc. 2021 May;54(3):363-370. doi: 10.5946/ce.2020.058. Epub 2020 Sep 8.
BACKGROUND/AIMS: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE.
Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated.
A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with IV fluorescein at 0.5 mg/kg.
In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both the upper and lower GI tract.
背景/目的：基于探头的共聚焦激光内镜检查（pCLE）需要静脉注射（IV）荧光素。本研究旨在确定上、下消化道（GI）pCLE的最佳静脉注射荧光素剂量。
年龄在20至79岁之间、患有胃高级别异型增生（HGD）或结直肠肿瘤（CRNs）的患者纳入本研究。采用剂量递减法，分为五个水平。本研究的主要终点是确定消化道pCLE的最佳静脉注射荧光素剂量。降低的剂量由三名内镜医师通过离线评估确定。荧光素剂量不足定义为pCLE图像不可见时的荧光素剂量。如果所有三名内镜医师都确定组织结构可见，则降低剂量。
本研究共纳入12例胃HGD患者和12例CRNs患者。非肿瘤性十二指肠和结肠黏膜的荧光素剂量均递减至0.5mg/kg。所有胃HGD或CRNs在静脉注射0.5mg/kg荧光素的pCLE下均可见。
在本研究中，静脉注射0.5mg/kg荧光素的pCLE足以观察上、下消化道的放大结构。
