EUS-guided in vivo imaging of the porcine esophageal enteric nervous system by using needle-based confocal laser endomicroscopy

Samarasena, Jason; Tarnawski, Andrzej S.; Ahluwalia, Amrita; Shinoura, Susumu; Choi, Kee Don; Lee, John G.; Chang, Kenneth J.

doi:10.1016/j.gie.2015.06.048

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…Samarasena [ 14 ] reported esophageal ENS visualization with needle-type CLE (nCLE: Mauna Kea Technologies, Paris, France) under endoscopic ultrasound (EUS) guidance. This technique was able to visualize the ENS without mucosal resection.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the human enteric nervous system by probe confocal laser endomicroscopy: a first real-time observation of Hirschsprung’s disease and allied disorders

et al. 2021

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Background Our group previously proved that the human enteric nervous system can be visualized with confocal laser endomicroscopy after topical application of cresyl violet using surgically resected intestine specimens. The present report documents the first in vivo visualization of the human enteric nervous system with confocal laser endomicroscopy using local cresyl violet staining. The aim of this study was to evaluate the technical feasibility and clinical efficiency of confocal laser endomicroscopy in patients with Hirschsprung’s disease and allied disorders in vivo. Methods Confocal laser endomicroscopy was performed in vivo in two patients to confirm the presence of the enteric nervous system during surgery in patients with Hirschsprung’s disease and allied disorders. Cresyl violet was gently injected from the serosal side into the muscular layer of the intestine, and scanning was performed within 30 min. Then, the scanned intestines were resected, and the visualized area of the specimens was pathologically evaluated. Results The ganglion cell nuclei and the enteric nervous system network were clearly visualized intraoperatively in both cases. The morphological findings were similar to the pathological findings of the enteric nervous system in both cases although the period of visibility was brief. Conclusion This study demonstrated the first, real-time observation of the enteric nervous system in humans using confocal laser endomicroscopy and suggest the potential to identify the enteric nervous system intra-operatively during surgery for Hirschsprung’s disease and allied disorders.

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Section: Discussionmentioning

confidence: 99%

Visualization of the human enteric nervous system by probe confocal laser endomicroscopy: a first real-time observation of Hirschsprung’s disease and allied disorders

et al. 2021

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“…Upon introducing the fluorescent agent to a primary culture of human pericytes, green fluorescence was observed ( Kim et al, 2022 ). In the study of gastrointestinal motility disease, researchers utilized a confocal laser microendoscope to observe neuronal cells and neural fiber networks in the submucosa and muscle lumina without the need for invasive mucosal resection by activating NeuroTrace ( Samarasena et al, 2015 ; Samarasena et al, 2016 ). In the mouse brain, NeuroTrace did not enter either neurons or glial cells, indicating that its transport system likely involves molecules expressed by human and rodent pericytes.…”

Section: Neuro-nonspecific Agentsmentioning

confidence: 99%

Advances in optical molecular imaging for neural visualization

Wei,

Liu,

Liang

et al. 2023

Front. Bioeng. Biotechnol.

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Iatrogenic nerve injury is a significant complication in surgery, which can negatively impact patients’ quality of life. Currently, the main clinical neuroimaging methods, such as computed tomography, magnetic resonance imaging, and high-resolution ultrasonography, do not offer precise real-time positioning images for doctors during surgery. The clinical application of optical molecular imaging technology has led to the emergence of new concepts such as optical molecular imaging surgery, targeted surgery, and molecular-guided surgery. These advancements have made it possible to directly visualize surgical target areas, thereby providing a novel method for real-time identification of nerves during surgery planning. Unlike traditional white light imaging, optical molecular imaging technology enables precise positioning and identifies the cation of intraoperative nerves through the presentation of color images. Although a large number of experiments and data support its development, there are few reports on its actual clinical application. This paper summarizes the research results of optical molecular imaging technology and its ability to realize neural visualization. Additionally, it discusses the challenges neural visualization recognition faces and future development opportunities.

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“…After establishing EUS-guided FNA, I started developing EUS-guided FNI (fine needle injection), including the delivery of anti-tumor agents and EUS-guided brachytherapy[184-197]. This then led to EUS-guided fine needle imaging with through-the-needle fiber optic probe combined with endomicroscopy in the evaluation of pancreatic cystic neoplasia[118,119,198-203]. EUS-guided FNA eventually become the mainstream modality for the tissue diagnosis of pancreatic cancer[185,204-209].…”

Section: Endo-hepatologymentioning

confidence: 99%

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

Chang

2019

WJG

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In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic, the content will progress as follows: “lessons learned”, “technical considerations” and “future opportunities”. Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years. Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as “the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver, pancreas, and part of the duodenum develop”. Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula, Barrett’s esophagus (BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors. For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy (POEM) which was developed in Japan, has become an alternative to the traditional Heller’s myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker’s diverticula with improved technique (Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection (ESD) which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies (radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett’s and related dysplasia and early cancer can be managed predominantly by endoscopy. Importantly, in regard to early gastric cancer and submucosal tumors (SMTs) of the stomach, ESD and full thickness resection (FTR) can excise these lesions en-bloc and endoscopic suturing is now used to close large defects and perforations. For treatment of patients with malignant gastric outlet obstruction (GOO), endoscopic gastro-jejunostomy is now showing better results ...

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EUS-guided in vivo imaging of the porcine esophageal enteric nervous system by using needle-based confocal laser endomicroscopy

Cited by 6 publications

References 18 publications

Visualization of the human enteric nervous system by probe confocal laser endomicroscopy: a first real-time observation of Hirschsprung’s disease and allied disorders

Visualization of the human enteric nervous system by probe confocal laser endomicroscopy: a first real-time observation of Hirschsprung’s disease and allied disorders

Advances in optical molecular imaging for neural visualization

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

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