BACKGROUND AND AIMSConfocal laser endomicroscopy is a novel technique to analyze living cells during ongoing endoscopy. Total proctocolectomy with ileal pouch anal anastomosis is the surgical procedure of choice for the management of ulcerative colitis and familial adenomatous polyposis. Pouchitis, a non-specific inflammation of the ileal reservoir, and dysplasia may affect the pouch after surgery. The aim of the present study was to assess the suitability of confocal laser endomicroscopy for the in-vivo diagnosis of mucosal changes in the ileal pouch.
METHODSVideo endoscopy and fluorescein-aided endomicroscopy (EC-3870CIFK; Pentax, Tokyo, Japan) were performed in the four quadrants of the proximal, middle and distal parts of the pouch in 18 patients. Any lesions, if present, were also analyzed. Targeted biopsies were taken. Confocal images and histological findings were analyzed for the presence of villous atrophy, inflammation, ulceration, colonic metaplasia and dysplasia. At endomicroscopy these parameters were defined according to a new Pouchitis Confocal Endomicroscopy Scale (see Table). Considering the presence of abnormalities in at least one of the above parameters in at least one of the confocal image/biopsy from the reservoir, sensitivity, specificity, positive and negative predictive values, and accuracy rates were calculated for the prediction of morphological changes of the pouch.
RESULTS CONCLUSIONSOn the basis of these preliminary results, the presence of morphological changes of the pouch could be predicted with an accuracy of 94,4%.Endomicroscopy may be helpful in evaluating the ileal reservoir after restorative proctocolectomy and may lead to a significant improvement in the in-vivo surveillance of the pouch.
Tumors of the angle of Treitz are a rare entity. Only 3%-5% of gastrointestinal stromal tumors (GISTs) occur at the level of the duodenum, and their location at the duodenojejunal junction is very uncommon. Surgery is the treatment of choice, while adjuvant medical therapy is used on the basis of the degree of radicality of the excision and the tumor's proliferative profile. These factors primarily influence the prognosis. Due to the frailty of the vascular viability of the left duodenum, which can be injured during surgery, it is generally recommended to perform digestive reconstruction at the level of the right portion of the duodenum. We here report the case of a patient with a large GIST located at the duodenojejunal junction behind the ligament of Treitz. We found reconstructive digestive anastomosis at the level of the third part of the duodenum to be a safe procedure.
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