John Gásdal Karstensen1, Adrian Săftoiu2, Jørn Brynskov1, Jakob Hendel1, Adriana Ciocalteu2, Pia Klausen1, Tobias Wirenfeldt Klausen3, Lene Buhl Riis4, Peter Vilmann1. 1. Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark. 2. Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania. 3. Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark. 4. Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark.
Abstract
BACKGROUND AND AIMS: Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment. METHODS: Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were enrolled. The colonic mucosa was examined with high-definition colonoscopy, histopathology, and CLE at 4 colonic sites. Subsequently, patients requiring medical treatment escalation were referred for repeat endoscopy with CLE after 6 to 8 weeks. RESULTS: The baseline frequency of fluorescein leakage (P < .001), microerosions (P < .001), tortuosity of the crypts (P = .001), distortion of the crypts openings (P = .001), presence of inflammatory infiltrates (P < .001), and decreased crypt density (P < .001) were significantly higher in active ulcerative colitis compared with inactive ulcerative colitis and control subjects. A decrease in histopathologic score after medical treatment escalation was correlated with improvement in crypt tortuosity (rs = .35, P = .016), distortion of crypt openings (rs = .30, P = .045), and decreased crypt density (rs = .33, P = .026) but not in other features. CONCLUSIONS: CLE is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01684514.).
BACKGROUND AND AIMS: Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment. METHODS: Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were enrolled. The colonic mucosa was examined with high-definition colonoscopy, histopathology, and CLE at 4 colonic sites. Subsequently, patients requiring medical treatment escalation were referred for repeat endoscopy with CLE after 6 to 8 weeks. RESULTS: The baseline frequency of fluorescein leakage (P < .001), microerosions (P < .001), tortuosity of the crypts (P = .001), distortion of the crypts openings (P = .001), presence of inflammatory infiltrates (P < .001), and decreased crypt density (P < .001) were significantly higher in active ulcerative colitis compared with inactive ulcerative colitis and control subjects. A decrease in histopathologic score after medical treatment escalation was correlated with improvement in crypt tortuosity (rs = .35, P = .016), distortion of crypt openings (rs = .30, P = .045), and decreased crypt density (rs = .33, P = .026) but not in other features. CONCLUSIONS: CLE is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01684514.).
Authors: Gheorghe Hundorfean; Stephen P Pereira; John G Karstensen; Peter Vilmann; Adrian Saftoiu Journal: Gastroenterol Res Pract Date: 2018-05-31 Impact factor: 2.260
Authors: Sebastian Kjærgaard; Morten M B Damm; Joan Chang; Lene B Riis; Hanne B Rasmussen; Rasmus Hytting-Andreasen; Susanne M Krug; Jörg-Dieter Schulzke; Niels Bindslev; Mark Berner Hansen Journal: Int J Mol Sci Date: 2020-03-10 Impact factor: 5.923
Authors: John Gásdal Karstensen; Tatiana Cârţână; Codruţa Constantinescu; Silviu Dumitrașcu; Bojan Kovacevic; Pia Klausen; Hazem Hassan; Tobias Wirenfeldt Klausen; Helga Bertani; Manoop S Bhutani; Adrian Săftoiu; Peter Vilmann Journal: Endosc Int Open Date: 2018-01-16