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Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy

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World Journal of Gastroenterology 2017年第1期23卷 25-41页

作者： Andrada Seicean Ofelia Mosteanu Radu Seicean Regional Institute of Gastroenterology and Hepatology Cluj-Napoca University of Medicine and Pharmacy“Iuliu Hatieganu” First Surgical Clinic Cluj-Napoca University of Medicine and Pharmacy“Iuliu Hatieganu”

New technologies in endoscopic ultrasound(EUS) evaluation have been developed because of the need to improve the EUS and EUS-fine needle aspiration(EUS- FNA) diagnostic rate. This paper reviews the principle, indications, main literature results, limitations and future expectations for each of the methods presented. Contrast-enhanced harmonic EUS uses a low mechanical index and highlights slowflow vascularization. This technique is useful for differentiating solid and cystic pancreatic lesions and assessing biliary neoplasms, submucosal neoplasms and lymph nodes. It is also useful for the discrimination of pancreatic masses based on their qualitative patterns; however, the quantitative assessment needs to be improved. The detection of small solid lesions is better, and the EUS-FNA guidance needs further research. The differentiation of cystic lesions of the pancreas and the identification of the associated malignancy features represent the main indications. Elastography is used to assess tissue hardness based on the measurement of elasticity. Despite its low negative predictive value, elastography might rule out the diagnosis of malignancy for pancreatic masses. Needle confocal laser endomicroscopy offers useful information about cystic lesions of the pancreas and is still under evaluation for use with solid pancreatic lesions of lymph nodes.

关键词： Endosonography Endosonography 好的针渴望提高对比泛音 Elastography endomicroscopy 胰淋巴节点包囊

GASTROINTESTINAL ABNORMALITIES IDENTIFIED BY FLUORESCENCE endomicroscopy

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Journal of Innovative Optical Health Sciences 2012年第4期5卷 33-38页

作者： HONGCHUN BAO ALEX BOUSSIOUTAS MCGEAREY ALEIXANDRIA RITA BUSUTTIL MIN GU Center for Micro-Photonics Faculty of Engineering and Industrial Sciences Swinburne University of Technology Hawthorn Victoria 3122Australia Research-Peter MacCallum Cancer Center 1 St Andrews Place East Melbourne Victoria 3002Australia Department of Medicine(RMH)University of Melbourne Royal Melbourne HospitalParkvilleVictoria 3050Australia

Real-tine in vivo microscopic imaging has becomne a reality with the advent of confocal and nonlinear endomicroscopy.These devices are best utilized in conjunction with standard white light endoscopy.We evaluated the use of fuorescence endomicroscopy in detecting microscopic abnormalities in colonic tisues.Mice of C57bl/6 strain had intraperitoneal injection with azoxymethane once every week for five weeks and littermates,not exposed to azoxymethane served as controls.After 14 weeks,intestines were imaged by fuorescence endomicroscopy.The images show obvious cellular structural diferences between those two groups of mice.The difference in endomicroscopy imaging can be used for identifying tissues suspicious for neoplasia or other changes,leading to early diagnosis of gastrointestinal track of cancer.

关键词： endomicroscopy fuorescence imaging one photon fluorescence imaging gastroin-testinal cancers goblet cells neoplasia

Confocal endomicroscopy and cyst fluid molecular analysis: Comprehensive evaluation of pancreatic cysts

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World Journal of Gastrointestinal Endoscopy 2018年第1期10卷 1-9页

作者： Feng Li Ahmad Malli Zobeida Cruz-Monserrate Darwin L Conwell Somashekar G Krishna Division of Gastroenterology Hepatology and Nutrition Ohio State University Wexner Medical Center

Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions(PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.

关键词： Pancreas Pancreatic cyst Pancreatic adenocarcinoma Confocal endomicroscopy Next generation sequencing Molecular marker

Confocal endomicroscopy:Is it time to move on?

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World Journal of Gastrointestinal Endoscopy 2016年第1期8卷 1-3页

作者： Carlos Robles-Medranda Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasUniversity Hospital OMNIGuayaquil 090505Ecuador

Confocal laser endomicroscopy permits in-vivo microscopy evaluation during endoscopy procedures. It can be used in all the parts of the gastrointestinal tract and includes: Esophagus,stomach,small bowel,colon,biliary tract through and endoscopic retrograde cholangiopancreatography and pancreas through needles during endoscopic ultrasound procedures. Many researches demonstrated a high correlation of results between confocal laser endomicroscopy and histopathology in the diagnosis of gastrointestinal lesions; with accuracy in about 86% to 96%. Moreover,in spite that histopathology remains the gold-standard technique for final diagnosis of any diseases; a considerable number of misdiagnosis rate could be present due to many factors such as interpretation mistakes,biopsy site inaccuracy,or number of biopsies. Theoretically; with the diagnostic accuracy rates of confocal laser endomicroscopy could help in a daily practice to improve diagnosis and treatment management of the patients. However,it is still not routinely used in the clinical practice due to many factors such as cost of the procedure,lack of codification and reimbursement in some countries,absence of standard of care indications,availability,physician imageinterpretation training,medico-legal problems,and the role of the pathologist. These limitations are relative,and solutions could be found based on new researches focused to solve these barriers.

关键词： Confocal laser endomicroscopy In-vivomicroscopy Barret esophagus Gastrointestinal cancer Confocal laser endomicroscopy probe

Probe based confocal laser endomicroscopy of the pancreatobiliary system

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World Journal of Gastroenterology 2015年第44期21卷 12696-12708页

作者： Majid A Almadi Helmut Neumann Division of Gastroenterology Department of Medicine King Saud University Medical City King Saud University Division of Gastroenterology The Mc Gill University Health Center Montreal General Hospital Mc Gill University Department of Medicine I University of Erlangen-Nuremberg

AIM:To review applications of confocal laser endomicroscopy(CLE) in pancreatobiliary lesions and studies that assessed training and interpretation of images. METHODS: A computerized literature search was performed using OVID MEDLINE, EMBASE, Cochrane library, and the ISI Web of Knowledge from 1980 to October 2014. We also searched abstracts from major meetings that included the Digestive Disease Week, Canadian Digestive Disease Week and the United European Gastroenterology Week using a combination of controlled vocabulary and text words related to p CLE, confocal, endomicroscopy, probe-based confocal laser endomicroscopy, and bile duct to identify reports of trials. In addition, recursive searches and crossreferencing was performed, and manual searches of articles identified after the initial search was also completed. We included fully published articles and those in abstract form. Given the relatively recent introduction of CLE we included randomized trials and cohort studies.R E S U LT S : In the evaluation of indeterminate pancreatobiliary strictures CLE with ERCP compared to ERCP alone can increase the detection of cancerous strictures with a sensitivity of(98% vs 45%) andhas a negative predictive value(97% vs 69%), but decreased the specificity(67% vs 100%) and the positive predictive value(71% vs 100%) when compared to index pathology. Modifications in the classification systems in indeterminate biliary strictures have increased the specificity of p CLE from 67% to 73%. In pancreatic cystic lesions there is a need to develop similar systems to interpret and characterize lesions based on CLE images obtained. The presence of superficial vascular network predicts serous cystadenomas accurately. Also training in acquiring and interpretation of images is feasible in those without any prior knowledge in CLE in a relatively simple manner and computer-aided diagnosis software is a promising innovation. CONCLUSION: The role of p CLE in the evaluation of pancreatobiliary disorders might be better suited for those wi

关键词： Probe based confocal laser endomicroscopy Confocal

Detection of superficial esophageal squamous cell neoplasia by chromoendoscopy-guided confocal laser endomicroscopy

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World Journal of Gastroenterology 2015年第22期21卷 6974-6981页

作者： Jin Huang Yun-Sheng Yang Zhong-Sheng Lu Shuang-Fang Wang Jing Yang Jing Yuan Department of Gastroenterology and Hepatology Chinese PLA 153 Hospital Department of Gastroenterology and Hepatology Chinese PLA General Hospital Department of Pathology Chinese PLA General Hospital

AIM: To evaluate the diagnostic potential of Lugol'schromoendoscopy-guided confocal laser endomicroscopy(CLE) in detecting superficial esophageal squamous cell neoplasia(ESCN).METHODS: Between December 2008 and September2010, a total of 52 patients were enrolled at the Chinese PLA General Hospital in Beijing, China. First,Lugol's chromoendoscopy-guided CLE was performed in these patients and the CLE in vivo histological diagnosis was recorded. Then, chromoendoscopyguided biopsy was performed in the same patients by another endoscopist who was blinded to the CLE findings. Based on the biopsy and CLE diagnosis, en bloc endoscopic resection was performed. The CLE in vivo diagnosis and the histological diagnosis of biopsy of ESCN were compared, using a histological examination of the endoscopic resection specimens as the standard reference.RESULTS: A total of 152 chromoendoscopy-guided biopsies were obtained from 56 lesions. In the 56 lesions of 52 patients, a total of 679 CLE images were obtained vs 152 corresponding biopsies. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE compared with biopsy were 95.7% vs 82%(P 0.05), respectively.There was a significant improvement in sensitivity,specificity, negative predictive value, and accuracy when comparing chromoendoscopy-guided CLE with biopsy.CONCLUSION: Lugol's chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.

关键词： Superficial esophageal neoplasia Squamous cell neoplasm Confocal endomicroscopy Endoscopicsubmucosal dissection Chromoendoscopy

Poor agreement between endoscopists and gastrointestinal pathologists for the interpretation of probe-based confocal laser endomicroscopy findings

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World Journal of Gastroenterology 2014年第47期20卷 17993-18000页

作者： Shajan Peter Leona Council Ji Young Bang Helmut Neumann Klaus Mnkemüller Shyam Varadarajulu Charles Melbern Wilcox Division of Gastroenterology and Hepatology University of AlabamaBirminghamAL 35294-0012United States Department of Pathology University of Alabama at BirminghamBirminghamAL 35294-0012United States Department of Medicine 1 University of Erlangen-Nuremberg91054 ErlangenGermany

AIM:To compare the interpretation of probe-based confocal laser endomicroscopy(p CLE)findings between endoscopists and gastrointestinal(GI)-pathologists.METHODS:All p CLE procedures were undertaken and the endoscopist rendered assessment.The same p CLE videos were then viewed offline by an expert GI pathologist.Histopathology was considered the gold standard for definitive diagnosis.The sensitivity,specificity and accuracy for diagnosis of dysplastic/neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for p CLE findings were analyzed.RESULTS:Of the 66 included patients,40(60.6%)had lesions in the esophagus,7(10.6%)in the stomach,15(22.7%)in the biliary tract,3(4.5%)in the ampulla and 1(1.5%)in the colon.The overall sensitivity,specificity and accuracy for diagnosing dysplastic/neoplastic lesions using p CLE were higher for endoscopists than pathologist at 87.0%vs 69.6%,80.0%vs 40.0%and 84.8%vs 60.6%(P=0.0003),respectively.Area under the ROC curve(AUC)was greater for endoscopists than the pathologist(0.83 vs 0.55,P=0.0001).Overall agreement between endoscopists and pathologist was moderate for all GI lesions(K=0.43;95%CI:0.26-0.61),luminal lesions(K=0.40;95%CI:0.20-0.60)and those of dysplastic/neoplastic pathology(K=0.55;95%CI:0.37-0.72),the agreement was poor for benign(K=0.13;95%CI:-0.097-0.36)and pancreaticobiliary lesions(K=0.19;95%CI:-0.26-0.63).CONCLUSION:There is a wide discrepancy in the interpretation of p CLE findings between endoscopists and pathologist,particularly for benign and malignant pancreaticobiliary lesions.Further studies are needed to identify the cause of this poor agreement.

关键词： Confocal endomicroscopy Gastointestinal Interobser

Confocal laser endomicroscopy in inflammatory bowel diseases:Dream or reality?

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World Journal of Gastroenterology 2013年第34期19卷 5593-5597页

作者： Giovanni Domenico De Palma Antonio Rispo Giovanni Domenico De Palma Antonio RispoCenter of Excellence for Technical Innovation in SurgeryDepartment of Clinical Medicine and SurgeryUniversity "FedericoⅡ" of NaplesSchool of Medicine

Confocal laser endomicroscopy(CLE)is a newly introduced procedure that provide real-time,high-resolution imaging of the gastrointestinal mucosa during endoscopy,allowing the visualization of the pathology of the mucosal epithelium with its cellular and subcellular structures.Recently,the use of CLE was reported in the study of colonic mucosa in patients with inflammatory bowel diseases and in particular in patients affected by ulcerative colitis.CLE has the potential to have an important role in management of inflammatory bowel diseases(IBD)patients as it can be used to assess the grading of colitis and in detection of microscopic colitis in endoscopically silent segments.Moreover,CLE can be used in surveillance programs especially in highrisk patients.Finally,CLE has been effectively used in diagnosing a biliary dysplasia/neoplasia in patients with primary sclerosing cholangitis,a pathological condition frequently associated with IBD,with a coexisting bile duct stricture.

关键词： Inflammatory bowel diseases Endoscopy Confocal laser endomicroscopy Colon cancer Dysplasia

Histopathological confirmation of similar intramucosal distribution of fluorescein in both intravenous administration and local mucosal application for probebased confocal laser endomicroscopy of the normal stomach

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World Journal of Clinical Cases 2015年第12期3卷 993-999页

作者： Kouichi Nonaka Ken Ohata Shinichi Ban Shin Ichihara Rumi Takasugi Yohei Minato Tomoaki Tashima Yasushi Matsuyama Maiko Takita Nobuyuki Matsuhashi Helmut Neumann Department of Gastroenterology NTT Medical Center Tokyo Department of Pathology Dokkyo Medical University Koshigaya Hospital Department of Pathology Sapporo-Kosei General Hospital Division of Technical Service Department of Medicine 1 University of Erlangen-Nuremberg

Probe-based confocal laser endomicroscopy(p CLE) is capable of acquiring in vivo magnified cross-section images of the gastric mucosa. Intravenous injection of fluorescein sodium is used for confocal imaging. However, it is still under debate if local administration of the dye to the mucosa is also effective for confocal imaging as it is not yet clear if topical application also reveals the intramucosal distribution of fluorescein. The objective of this study was to evaluate the intramucosal distribution of fluorescein sodium after topical application and to compare the distribution to the conventional intravenous injection used for confocal imaging. p CLE of the stomach uninfected with Helicobacter pylori was performed in a healthy male employing intravenous administration and local mucosal application of fluorescein. The mucosa of the lower gastric body was biopsied 1 min and 5 min after intravenous administration or local mucosal application of fluorescein, and the distribution of fluorescein in the biopsy samples was examined histologically. Green fluorescence was already observed in the cytoplasm of fundic glandular cells in the biopsied deep mucosa 1 min after local mucosal application of fluorescein. It was also observed in the foveolar lumen and inter-foveolar lamina propria, although it was noted at only a few sites. In the tissue biopsied 5 min after the local mucosal application of fluorescein, green fluorescence was more frequently noted in the cytoplasm of fundic glandular cells than in that 1 min after the local mucosal application of fluorescein, although obvious green fluorescence was not identified in the foveolar lumen or inter-foveolar lamina propria. The distribution of intravenously administered fluorescein in the cytoplasm of fundic glandular cells was also clearly observed similarly to that after local mucosal application of fluorescein. Green fluorescence in more cells was observed in many cells 5 min after intravenous administration compared with that after 1 min. The presence of fluoresc

关键词： Confocal laser endomicroscopy Fluorescein Local application Intravenous Distribution