Classification of inflammation activity in ulcerative colitis by confocal laser endomicroscopy
发表时间：2010-06-18 10:20
OBJECTIVES: The assessment of infl ammation activity in ulcerative colitis (UC) includes endoscopy and histology. Confocal laser endomicroscopy (CLE) combines real-time endoscopy and histology. This study aimed at evaluating the application of CLE in the assessment of infl ammation activity in UC. METHODS: In total, 73 consecutive patients with UC who were visiting Qilu Hospital for colonoscopy surveil- lance underwent CLE. Infl ammation activity was fi rst assessed by the colonoscopy Baron score, then by CLE with a 4-grade classifi cation of crypt architecture, as well as by an analysis of microvascular alterations and fl uorescein leakage. Targeted biopsy samples were taken for histological analysis. Stored CLE images underwent post-CLE objective assessment. RESULTS: Both assessment of crypt architecture and fl uorescein leakage with CLE showed a good correlation with histological results (Spearman ’ s rho, both P < 0.001). CLE seemed to be more accurate than conventional white-light endoscopy for evaluating macroscopical normal mucosa. More than half of the patients with normal mucosa seen on conventional white-light endoscopy showed acute infl am- mation on histology, whereas no patients with normal mucosa or with chronic infl ammation seen on CLE showed acute infl ammation on histology. Assessment of microvascular alterations by CLE showed good correlation with histological fi ndings ( P < 0.001). On post-CLE objective assessment, subjective architectural classifi cations were supported by the number of crypts per image ( P < 0.001) but not fl uorescein leakage results by gray scale ( P = 0.194). CONCLUSIONS: CLE is reliable for real-time assessment of infl ammation activity in UC. Crypt architecture, microvascular alterations, and fl uorescein leakage are promising markers in CLE evaluation.
第一署名医院:山东大学齐鲁医院
