Mucosal barrier defects in gastric intestinal metaplasia: in vivo evaluation by confocal endomicroscopy
发表时间：2019-12-18 10:02
Background: Helicobacter pylori infection and intestinal metaplasia (IM) are associated with gastric cancer. An impaired gastric mucosal barrier could be involved in this carcinogenesis. Objective: To evaluate laser confocal laser endomicroscopy (CLE) for in vivo functional imaging of mucosal barrier defects in patients with IM. Design: Prospective, controlled study. Setting: A tertiary-care academic center. Patients: This study involved patients with IM of the gastric mucosa who underwent CLE for surveillance. Interventions: Specific IM mucosa and non-IM mucosa in patients were identified by CLE, and targeted biopsy samples were taken for histopathology and electron microscopy. Main Outcome Measurements: Post-CLE assessment of paracellular fluorescein leakage was devised and validated by electron microscopy. We also evaluated the effect of H pylori eradication on the mucosal barrier. Results: Forty-two patients were included. Of non-IM samples, the paracellular permeability was significantly increased in H pylori–positive samples compared with H pylori–negative controls (54 ? 31% vs 3 ? 6%, P ? .05). Of IM samples, the permeability was significantly increased in both H pylori–negative and H pylori–positive samples (67 ? 34% and 72 ? 28% vs 3 ? 6%, both P ? .05). The results of post-CLE assessment correlated well with the electron microscopy findings (R 2 0.834, P ? .0001). After the eradication of H pylori, the paracellular barrier dysfunction of non-IM mucosa was significantly improved as shown by electron microscopy and CLE (both P ? .001). However, there was no significant change in IM mucosa. Limitations: Single-center study. Conclusions: CLE allows functional imaging of mucosal barrier defects. Gastric IM is associated with an impaired paracellular barrier irrespective of H pylori eradication. (Gastrointest Endosc 2012;xx:xxx.)
第一署名医院：山东大学齐鲁医院
