Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications

Pilonis, Nastazja D.; Januszewicz, Władysław; Pietro, Massimiliano di

doi:10.21037/tgh.2020.04.02

Cited by 40 publications

(37 citation statements)

References 96 publications

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“…The term confocal refers to the alignment of the light source and the collection system in the same specimen plane. After the laser illuminates the specimen, the tissue emits fluorescence, which is detected by the collection system for image generation (25). The current generation CLE device we used was designed specifically to be integrated into the Bar chart showing a comparison of overall mean (SD) brightness and contrast of in vivo and ex vivo images.…”

Section: Discussionmentioning

confidence: 99%

Characterization of ex vivo and in vivo intraoperative neurosurgical confocal laser endomicroscopy imaging

Abramov

Belykh

et al. 2022

Front. Oncol.

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BackgroundThe new US Food and Drug Administration-cleared fluorescein sodium (FNa)-based confocal laser endomicroscopy (CLE) imaging system allows for intraoperative on-the-fly cellular level imaging. Two feasibility studies have been completed with intraoperative use of this CLE system in ex vivo and in vivo modalities. This study quantitatively compares the image quality and diagnostic performance of ex vivo and in vivo CLE imaging.MethodsImages acquired from two prospective CLE clinical studies, one ex vivo and one in vivo, were analyzed quantitatively. Two image quality parameters – brightness and contrast – were measured using Fiji software and compared between ex vivo and in vivo images for imaging timing from FNa dose and in glioma, meningioma, and intracranial metastatic tumor cases. The diagnostic performance of the two studies was compared.ResultsOverall, the in vivo images have higher brightness and contrast than the ex vivo images (p < 0.001). A weak negative correlation exists between image quality and timing of imaging after FNa dose for the ex vivo images, but not the in vivo images. In vivo images have higher image quality than ex vivo images (p < 0.001) in glioma, meningioma, and intracranial metastatic tumor cases. In vivo imaging yielded higher sensitivity and negative predictive value than ex vivo imaging.ConclusionsIn our setting, in vivo CLE optical biopsy outperforms ex vivo CLE by producing higher quality images and less image deterioration, leading to better diagnostic performance. These results support the in vivo modality as the modality of choice for intraoperative CLE imaging.

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Section: Discussionmentioning

confidence: 99%

Characterization of ex vivo and in vivo intraoperative neurosurgical confocal laser endomicroscopy imaging

Abramov

Belykh

et al. 2022

Front. Oncol.

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“…CLE is utilized in the detection of dysplasia, adenoma, and carcinoma. CLE has a high diagnostic accuracy for conditions affecting the gastrointestinal tract, such as esophageal, gastric, and colonic neoplasia, pancreatic cysts and solid lesions, and malignant pancreatobiliary strictures [15]. One single-center study comparing dual-focus narrow band imaging and CLE for realtime diagnosis of adenomatous polyps in patients with FAP, showed that CLE had a similar, high degree of diagnostic value as compared with narrow band imaging [16].…”

Section: Discussionmentioning

confidence: 99%

“…Confocal laser endomicroscopy (CLE) is an advanced endoscopic imaging technology that facilitates the observation of gastrointestinal epithelia at a magnified, cellular level [15]. CLE is utilized in the detection of dysplasia, adenoma, and carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of tumors of minor ampulla: a multicenter study

et al. 2022

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Background and study aims Papillary and duodenal carcinoma are aggressive cancers with poor 5-year survival rates. Papillectomy is a well-established treatment for early-stage carcinoma of the major papilla. Tumors arising in the minor papilla are relatively rare and there is little research available on the endoscopic management of these tumors. Patients and methods The purpose of this study was to establish the safety and efficacy of endoscopic papillectomy in the management of minor papillary tumors. A total of six patients undergoing ERCP for papillectomy for minor papillary tumor at four hospitals were included in this study over a period of 5 years. Results Papillectomy was technically successful in all six patients. Pathology revealed adenoma in three patients, adenoma with high-grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. For follow-up, one patient had an additional tumor identified at 2 years which was found to be a recurrence of the original adenoma. This patient was treated with repeat papillectomy with no further evidence of recurrence. Conclusions In our pilot study, we demonstrate that endoscopic papillectomy appears safe and effective in the management of minor papillary tumors.

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“…Recently, DEX has been demonstrated to improve pediatric MRI imaging (Mason et al, 2011). Its incorporation into modern clinical imaging workflows will require no modification to imaging technology and would likely be beneficial for physicians, as it would provide additional stabilization for images captured by next-generation endoscopes, colonoscopes, and laparoscopes equipped with cellular-resolution endomicroscopy technologies (Kim et al, 2012; Belykh et al, 2018; Lesur et al, 2019; Yin et al, 2019; Pilonis et al, 2022). However, in clinical settings, there are other methods for regulating the involuntary movement of patients.…”

Section: Discussionmentioning

confidence: 99%

Minimizing Motion Artifacts in Intravital Microscopy Using the Sedative Effect of Dexmedetomidine

Kim

Cho

Paulson

et al. 2022

Microscopy and Microanalysis

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Among intravital imaging instruments, the intravital two-photon fluorescence excitation microscope has the advantage of enabling real-time 3D fluorescence imaging deep into cells and tissues, with reduced photobleaching and photodamage compared with conventional intravital confocal microscopes. However, excessive motion of organs due to involuntary movement such as breathing may result in out-of-focus images and severe fluorescence intensity fluctuations, which hinder meaningful imaging and analysis. The clinically approved alpha-2 adrenergic receptor agonist dexmedetomidine was administered to mice during two-photon fluorescence intravital imaging to alleviate this problem. As dexmedetomidine blocks the release of the neurotransmitter norepinephrine, pain is suppressed, blood pressure is reduced, and a sedation effect is observed. By tracking the quality of focus and stability of detected fluorescence in two-photon fluorescence images of fluorescein isothiocyanate-sensitized liver vasculature in vivo, we demonstrated that intravascular dexmedetomidine can reduce fluorescence fluctuations caused by respiration on a timescale of minutes in mice, improving image quality and resolution. The results indicate that short-term dexmedetomidine treatment is suitable for reducing involuntary motion in preclinical intravital imaging studies. This method may be applicable to other animal models.

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Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications

Cited by 40 publications

References 96 publications

Characterization of ex vivo and in vivo intraoperative neurosurgical confocal laser endomicroscopy imaging

Characterization of ex vivo and in vivo intraoperative neurosurgical confocal laser endomicroscopy imaging

Endoscopic management of tumors of minor ampulla: a multicenter study

Minimizing Motion Artifacts in Intravital Microscopy Using the Sedative Effect of Dexmedetomidine

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