Confocal laser endomicroscopy for the detection of mucosal changes in ileal pouch after restorative proctocolectomy

Abstract

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.

Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis

“…Trovato et al (34) assessed ileal pouches using either confocal laser endomicroscopy in vivo or conventional histopathological analysis and found incidences of colonic metaplasia of 67.7% and 83.3%, respectively, as well as an incidence of villous atrophy of 83.3% using both techniques. In our study, both colonic metaplasia and villous atrophy were observed in 36.6% of patients, and no dysplasia was detected in either study.…”

Early Transcriptomic Changes in the Ileal Pouch Provide Insight into the Molecular Pathogenesis of Pouchitis and Ulcerative Colitis

“…Studies of the host have suggested that there may be partial colonic metaplasia that occurs in the ileal pouch. 7–9 Villus shortening and crypt hyperplasia have been described, though histologic changes appear to be patchy and inconsistent. Some have argued that these changes may be secondary to inflammation.…”

Advances in confocal laser endomicroscopy for the diagnosis of gastrointestinal diseases

“…In a case series of 18 patients, CLE was superior to white light endoscopy to identify patients with pouchitis [32]. With histopathology as the gold standard, CLE had an accuracy of 94.4% to define villous atrophy, inflammation, ulceration and colonic metaplasia in these patients, and was again used to target biopsies.…”