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. 2009 May 14;15(18):2214-9.
doi: 10.3748/wjg.15.2214.

Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

Krishnappa Venkatesh  1 , Marta Cohen, Clair Evans, Peter Delaney, Steven Thomas, Christopher Taylor, Ashraf Abou-Taleb, Ralf Kiesslich, Mike Thomson
Affiliations

Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

Krishnappa Venkatesh et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the feasibility and utility of confocal laser endomicroscopy (CLE) in the description of normal gastrointestinal (GI) mucosa and in the diagnosis of GI disorders in children, in comparison to histology.

Methods: Forty-four patients (19 female) median age 10.9 years (range 0.7-16.6 years) with suspected or known GI pathology underwent esophago-gastro-duodenoscopy (OGD) (n = 36) and/or ileocolonoscopy (IC) (n = 31) with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively.

Results: Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min (range 7-25 min) for OGD and 27.9 min (range 15-45 min) for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures. Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease.

Conclusion: CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.

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Figures

Figure 1
Figure 1
Comparison of confocal images with conventional histological images of the upper GI tract. A: Confocal image delineating the fine slender fingerlike projections of the duodenal villi; B: Confocal image showing gastric pits; C: Confocal image of non-keratinized squamous epithelium of the esophagus; D: Histological image of duodenum; E: Histological image of gastric antrum; F: Histological image of esophagus.
Figure 2
Figure 2
Comparison of confocal images with conventional histological images of the lower GI tract. A: Confocal image of normal colonic mucosa showing regularly spaced crypts; B: Comparative histological image.
Figure 3
Figure 3
Comparison of confocal with conventional histology in celiac disease. A: Histological image of celiac disease, Marsh type 3b; B: Comparative confocal image; C: Histological image of celiac disease, Marsh type 3c; D: Comparative confocal image.
Figure 4
Figure 4
Comparison of confocal with conventional histology in ulcerative colitis. A: Histologic image in Ulcerative colitis; B: Comparative confocal image showing bifid crypt (arrow), crypt destruction (arrow head), tortous vessels (double arrows).
See this image and copyright information in PMC

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