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Jeong E, Yoo IK, Yeniova AÖ, Yon DK, Cho JY. Confocal Laser Endomicroscopic Findings of Refractory Erosive Reflux Disease versus Non-Erosive Reflux Disease with Anti-Reflux Mucosectomy: An in vivo and ex vivo Study. Clin Endosc 2020; 54:55-63. [PMID: 32375457 PMCID: PMC7939765 DOI: 10.5946/ce.2020.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background/Aims To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is a non-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has been shown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo and ex vivo through CLE in patients with GERD.
Methods Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed in vivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular and vascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group.
Results Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patients with ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter, number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in the NERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD.
Conclusions The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnose NERD with high sensitivity and accuracy.
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Affiliation(s)
- Eunju Jeong
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Abdullah Özgür Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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De Palma GD, Maione F, Esposito D, Luglio G, Giglio MC, Siciliano S, Gennarelli N, Cassese G, Campione S, D'Armiento FP, Bucci L. In vivo assessment of tumour angiogenesis in colorectal cancer: the role of confocal laser endomicroscopy. Colorectal Dis 2016; 18:O66-73. [PMID: 26589643 DOI: 10.1111/codi.13222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 10/08/2015] [Indexed: 12/13/2022]
Abstract
AIM Tumour neoangiogenesis is a key factor in tumour progression and metastatic spread and the possibility to assess tumour angiogenesis might provide prognostic information. The aim of this study was to establish the role of probe-based confocal laser endomicroscopy (p-CLE) in the identification of vascular architecture and specific morphological patterns in normal colorectal mucosa and malignant lesions during routine endoscopy. METHOD Fourteen consecutive patients with colorectal cancer were included. The following features were identified and then compared between normal and neoplastic mucosa on p-CLE images: vessel shape (straight vs irregular) vessel diameter the 'branching patterns' vessel permeability (fluorescein leakage) and blood flow (normal vs defective flux). Immunohistochemistry was used to confirm the presence and to study the morphology of vascular structures (CD-34 staining) and 'neo-vessels' (WT-1 staining) on tumour and normal mucosal sections. RESULTS Tumour vessels appeared as irregular, ectatic and with a highly variable calibre and branching patterns on p-CLE images. The mean diameter of tumour vessels was significantly larger than those in normal mucosa (weighted mean difference 3.38, 95% CI 2.65-4.11, P = 0.01). Similarly, 'vessel branching' (OR 2.74, 95% CI 1.23-6.14, P = 0.01), fluorescent dye 'extravasation' (OR 3.46, 95% CI 1.39-8.57, P = 0.01) were significantly more frequent in colorectal cancer than in normal colorectal mucosa. Immunohistochemistry corroborated the p-CLE findings, showing higher vascularity in tumour sections due to neoformed vessels, presenting irregular patterns. CONCLUSION Probe-based confocal laser endomicroscopy provides a noninvasive characterization of the microvascular architecture of colonic mucosa. Different morphological patterns have been described, discriminating normal and malignant microvascular networks in colorectal mucosa.
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Affiliation(s)
- G D De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - F Maione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - D Esposito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - G Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - M C Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - S Siciliano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - N Gennarelli
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - G Cassese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
| | - S Campione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, School of Medicine, Naples, Italy
| | - F P D'Armiento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, School of Medicine, Naples, Italy
| | - L Bucci
- Department of Clinical Medicine and Surgery, University of Naples Federico II, School of Medicine, Naples, Italy
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Wang J, Yang M, Yang L, Zhang Y, Yuan J, Liu Q, Hou X, Fu L. A Confocal Endoscope for Cellular Imaging. ENGINEERING 2015; 1:351-360. [DOI: 10.15302/j-eng-2015081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
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Abstract
Although removal of adenomatous polyps has been shown to decrease the risk of colon cancer, distal hyperplastic polyps are thought to not have malignant potential. Most polyps detected during colonoscopy are diminutive (≤ 5 mm) and rarely harbor advanced histology, such as high-grade dysplasia or cancer. Therefore, predicting histology in real-time during colonoscopy can potentially decrease the enormous expenditure that ensues from universal histopathologic evaluation of polyps, and several novel imaging technologies have been developed and tested over the past decade for this purpose. Of these different technologies, electronic chromoendoscopy seems to strike a fair balance between accuracy, feasibility, and cost.
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Affiliation(s)
- Shreyas Saligram
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA
| | - Amit Rastogi
- University of Kansas School of Medicine, University of Kansas, Department of Gastroenterology, 3901 Rainbow Blvd, Kansas City, KS 66160, USA; Veterans Affairs Medical Center, Department of Gastroenterology, 4801 Linwood Blvd, Kansas City, MO 64128, USA.
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Serrano M, Kikuste I, Dinis-Ribeiro M. Advanced endoscopic imaging for gastric cancer assessment: new insights with new optics? Best Pract Res Clin Gastroenterol 2014; 28:1079-91. [PMID: 25439073 DOI: 10.1016/j.bpg.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 09/22/2014] [Accepted: 10/01/2014] [Indexed: 01/31/2023]
Abstract
The most immediate strategy for improving survival of gastric cancer patients is secondary prevention through diagnosis of early gastric cancer either through screening or follow-up of individuals at high risk. Endoscopy examination is therefore of paramount importance and two general steps are to be known in assessing gastric mucosa - detection and characterization. Over the past decade, the advent of advanced endoscopic imaging technology led to diverse descriptions of these modalities reporting them to be useful in this setting. In this review, we aim at summarizing the current evidence on the use of advance imaging in individuals at high-risk (i.e., advance stages of gastric atrophy/intestinal metaplasia) and in those harbouring neoplastic lesions, and address its potential usefulness providing the readers a framework to use in daily practice. Further research is also suggested.
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Affiliation(s)
- M Serrano
- Gastroenterology Department, Portuguese Oncology Institute, Rua Professor Lima Basto, 1099-023 Lisbon, Portugal.
| | - I Kikuste
- Faculty of Medicine, University of Latvia, Riga, Latvia; Digestive Diseases Centre GASTRO, 6 Linezera Street, LV1006 Riga, Latvia.
| | - M Dinis-Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Porto Faculty of Medicine, Porto, Portugal; Gastroenterology Department, Portuguese Oncology Institute, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal.
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Lerner SP, Goh A. Novel endoscopic diagnosis for bladder cancer. Cancer 2014; 121:169-78. [PMID: 25132313 DOI: 10.1002/cncr.28905] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 12/13/2022]
Abstract
Advances in endoscopic imaging technology may improve sensitivity for the detection of bladder cancer and provide a more complete understanding of the urothelial landscape, and it also may lead to improved short-term and long-term cancer control. Fluorescence cystoscopy requires intravesical administration of a photosensitizing agent (5-aminolevulinic acid or hexaminolevulinate), and imaging with a blue-light endoscopy system demonstrably improves the detection of papillary and flat bladder lesions compared with conventional white-light cystoscopy. Prospective phase 3 clinical trials have demonstrated improved diagnostic ability, enhanced tumor resection, and a small but significant reduction in recurrence-free survival. Optical coherence tomography delineates subsurface microarchitecture information about bladder lesions in real time and has the ability to discriminate between noninvasive and invasive cancers. Narrow-band imaging may augment white-light cystoscopy by providing increased contrast between normal and abnormal tissue on the basis of neovascularity. Confocal laser endoscopy has been applied to the urinary tract using thinner probes adapted from use in gastrointestinal malignancies and provides exquisite images at microscopic resolution. More technology is on the horizon that may further enhance our ability to detect and accurately stage bladder tumors and distinguish benign from malignant or dysplastic lesions.
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Affiliation(s)
- Seth P Lerner
- Baylor College of Medicine, Scott Department of Urology, Baylor College of Medicine, Houston, Texas; Department of Urology, Houston Methodist Hospital, Houston, Texas
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Perioperative characterization of anastomotic doughnuts with high-resolution probe-based confocal laser endomicroscopy in colorectal cancer surgery: a feasibility study. Surg Endosc 2014; 28:2072-7. [PMID: 24519027 DOI: 10.1007/s00464-014-3429-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
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