Intravenous Fluorescein Administration Safety at Confocal Laser Endomicroscopy of Gastrointestinal Tract in Children

Abstract

Confocal laser endomicroscopy (CLE) is a method of optic biopsy, which allows obtaining histologic presentation of mucous tunic in real time IntroductionDetailed visualization of the digestive tract's mucous tunic is necessary for early diagnostics of a disease. Probe-based confocal laser endomicroscopy (pCLE) is a new method of gastrointestinal endoscopy, which yields images of mucous tunic of ca. 1 micron resolution and visualizes cellular and subcellular structures, capillaries and singular blood cells. The available published data indicate high interconnection of confocal endomicroscopy intravital images with the traditional histology of the unaltered digestive tract's mucous tunic [1,2]. The technique allows quickly differentiating between an inflamed, metaplastic or dysplastic mucous tunic; without any doubt, this increases interest in the use of this technique in clinical practice for diagnosis of such diseases as Barrett esophagus, gastric metaplasia of esophagus, neoplasms, inflammatory diseases of large and small intestines, Helicobacter pylori, celiac disease etc. It should be noted, that it is necessary to administer a diagnostic agent intravenously in order to obtain high-contrast images at pCLE of digestive tract. 10% sodium fluorescein solution may be used; it is widely applied in diagnostic practice in adult patients [2,3]. In 2008, the Ministry of Health of the RF approved intravenous fluorescein administration for evaluation of eye fundus condition using a confocal laser ophthalmoscope (Registration number LRS-000829/08 of 18.02.08); the procedure itself appeared to be of excellent safety level in pediatric ophthalmology [3]. This study is relevant due to the lack of direct indication in the world pediatric practice to intravenous administration of this pCLE-required diagnostic agent.