AIM： To evaluate a newly developed hand-held confocal probe for in vivo microscopic imaging of the complete gastrointestinal tract in rodents. METHODS： A novel rigid confocal probe （diameter 7 mm） was designed wit...AIM： To evaluate a newly developed hand-held confocal probe for in vivo microscopic imaging of the complete gastrointestinal tract in rodents. METHODS： A novel rigid confocal probe （diameter 7 mm） was designed with optical features similar to the flexible endomicroscopy system for use in humans using a 488 nm single line laser for fluorophore excitation, Light emission was detected at 505 to 750 nm. The field of view was 475 μm × 475 μm. Optical slice thickness was 7 μm with a lateral resolution of 0.7 μm. Subsurface serial images at different depths （surface to 250 μm） were generated in real time at 1024 × 1024 pixels （0.8 frames/s） by placing the probe onto the tissue in gentle, stable contact. Tissue specimens were sampled for histopathological correlation.RESULTS： The esophagus, stomach, small and large intestine and meso, liver, pancreas and gall bladder were visualised in vivo at high resolution in n = 48 mice. Real time microscopic imaging with the confocal minimicroscopy probe was easy to achieve. The different staining protocols （fluorescein, acriflavine, FITC-labelled dextran and L. esculentum lectin） each highlighted specific aspects of the tissue, and in vivo imaging correlated excellently with conventional histology. In vivo blood flow monitoring added a functional quality to morphologic imaging.CONCLUSION： Confocal microscopy is feasible in vivo allowing the visualisation of the complete GI tract at high resolution even of subsurface tissue structures. The new confocal probe design evaluated in this study is compatible with laparoscopy and significantly expands the field of possible applications to intra-abdominal organs. It allows immediate testing of new in vivo staining and application options and therefore permits rapid transfer from animal studies to clinical use in patients.展开更多
AIM: To evaluate the diagnostic yield(inflammatory activity) and efficiency(size of the biopsy specimen) of SpyGlassTM-guided biopsy vs standard brush cytology in patients with and without primary sclerosing cholangit...AIM: To evaluate the diagnostic yield(inflammatory activity) and efficiency(size of the biopsy specimen) of SpyGlassTM-guided biopsy vs standard brush cytology in patients with and without primary sclerosing cholangitis(PSC).METHODS: At the University Medical Center Mainz, Germany, 35 consecutive patients with unclear biliarylesions(16 patients) or long-standing PSC(19 patients) were screened for the study. All patients underwent a physical examination, lab analyses, and abdominal ultrasound. Thirty-one patients with non-PSC strictures or with PSC were scheduled to undergo endoscopic retrograde cholangiography(ERC) and subsequent per-oral cholangioscopy(POC). Standard ERC was initially performed, and any lesions or strictures were localized. POC was performed later during the same session. The Boston Scientific SpyGlass SystemTM(Natick, MA, United States) was used for choledochoscopy. The biliary tree was visualized, and suspected lesions or strictures were biopsied, followed by brush cytology of the same area. The study endpoints(for both techniques) were the degree of inflammation, tissue specimen size, and the patient populations(PSC vs non-PSC). Inflammatory changes were divided into three categories: none, low activity, and high activity. The specimen quantity was rated as low, moderate, or sufficient.RESULTS: SpyGlassTM imaging and brush cytology with material retrieval were performed in 29 of 31(93.5%) patients(23 of the 29 patients were male). The median patient age was 45 years(min, 20 years; max, 76 years). Nineteen patients had known PSC, and 10 showed non-PSC strictures. No procedure-related complications were encountered. However, for both methods, tissues could only be retrieved from 29 pa-tients. In cases of inflammation of the biliary tract, the diagnostic yield of the SpyGlassTM-directed biopsies was greater than that using brush cytology. More tissue material was obtained for the biopsy method than for the brush cytology method(P = 0.021). The biopsies showed significantly more inflammatory characteristics and greater inflammatory activity compared to the cy-tological investigation(P = 0.014). The greater quantity of tissue samples proved useful for both PSC and non-PSC patients.CONCLUSION: SpyGlassTM imaging can be recom-mended for proper inflammatory diagnosis in PSC pa-tients. However, its value in diagnosing dysplasia wasnot addressed in this study and requires further investi-gation.展开更多
AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)an...AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)and 19 with systemic sclerosis(SSc)were prospectively selected from a total of 115patients at a single university centre and esophageal motility was analysed using standard manometry(Mui Scientific PIP-4-8SS).All patients underwent esophagogastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study.All patients underwent a complete physical,blood biochemistry and urinary examination.The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms.Furthermore,disease activity scores(SLEDAI and modified Rodnan score)were obtained for patients with autoimmune diseases.Outcome parameter:A correlation coefficient was calculated between amplitudes,velocity and duration of the peristaltic waves throughout esophagus and patients’dysphagia for all three groups.RESULTS:There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups.Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc.The mean value of dysphagia score was in IBS group 7.3,in SLE group 6.73 and in SSc group7.56 with a P-value>0.05.However,the manometric patterns were different.IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in46%of the patients,which was significant higher in comparison to the SLE(11.8%)and SSc-Group(0%,P=0.003).Furthermore,IBS patients showed lower mean resting pressure of the distal esophagus sphincter(Lower esophageal sphincter,22 mmHg)when compared with SLE(28 mmHg,P=0.037)and SSc(26 mmHg,P=0.052).23.5%of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus(IBS and SSc:0%)whereas 29.4%amplitudes greater as 100 mmHg in the middle one(IBS:16.7%,SSc:5.9%respectively,P=0.006).Patients with SSc demonstrated,as expected,in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus.SSc patients demonstrated a negative correlation coefficient between dysphagia score,amplitude and velocity of peristaltic activity at middle and lower esophagus[r=-0.6,P<CONCLUSION:IBS patients have comparable dysphagia-scores as patients with autoimmune disorders.The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.展开更多
AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accor...AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accordance with the risk profile for the development of colorectal carcinoma,the study participants were divided into high-risk and low-risk groups.Individuals with just one criterion(age > 70 years,adenoma in medical history,and first-degree relative with colorectal cancer) were regarded as high-risk patients.Bowel preparation was performed in a standardized manner one day before the procedure.Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-m L syringe followed by a second colonoscopy that included irrigation by the use of the Jet Prep cleansing system.The reverse sequence was used in the control arm.The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.RESULTS: A total of 64 patients(34 men and 30 women) were included in the study; 22 were included in the high-risk group.After randomization,30 patients were assigned to the control group(group A) and 34 to the intervention group(group B).The average Boston Bowel Preparation Scale score was 5.15 ± 2.04.The withdrawal time needed for the first step was significantly longer in group A using the Jet Prep system(9.41 ± 3.34 min) compared to group B(7.5 ± 1.92 min).A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps.In group A,49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%.Group B underwent cleansing with the Jet Prep system during the first examination step,and as many as 73.9% of polyps were identified during this step.Thus,the miss rate in group B was a mere 26.1%(P < 0.001).When considering only the right side of the colon,the miss rate in group A during the first examination was 60.6%,in contrast to a miss rate of 26.4% in group B(P < 0.001).CONCLUSION: Jet Prep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection,particularly in the proximal colon.展开更多
基金Supported by Group for Minimal-invasive Chirurgie, Johannes Gutenberg-Universitat, Mainz, Germany
文摘AIM： To evaluate a newly developed hand-held confocal probe for in vivo microscopic imaging of the complete gastrointestinal tract in rodents. METHODS： A novel rigid confocal probe （diameter 7 mm） was designed with optical features similar to the flexible endomicroscopy system for use in humans using a 488 nm single line laser for fluorophore excitation, Light emission was detected at 505 to 750 nm. The field of view was 475 μm × 475 μm. Optical slice thickness was 7 μm with a lateral resolution of 0.7 μm. Subsurface serial images at different depths （surface to 250 μm） were generated in real time at 1024 × 1024 pixels （0.8 frames/s） by placing the probe onto the tissue in gentle, stable contact. Tissue specimens were sampled for histopathological correlation.RESULTS： The esophagus, stomach, small and large intestine and meso, liver, pancreas and gall bladder were visualised in vivo at high resolution in n = 48 mice. Real time microscopic imaging with the confocal minimicroscopy probe was easy to achieve. The different staining protocols （fluorescein, acriflavine, FITC-labelled dextran and L. esculentum lectin） each highlighted specific aspects of the tissue, and in vivo imaging correlated excellently with conventional histology. In vivo blood flow monitoring added a functional quality to morphologic imaging.CONCLUSION： Confocal microscopy is feasible in vivo allowing the visualisation of the complete GI tract at high resolution even of subsurface tissue structures. The new confocal probe design evaluated in this study is compatible with laparoscopy and significantly expands the field of possible applications to intra-abdominal organs. It allows immediate testing of new in vivo staining and application options and therefore permits rapid transfer from animal studies to clinical use in patients.
文摘AIM: To evaluate the diagnostic yield(inflammatory activity) and efficiency(size of the biopsy specimen) of SpyGlassTM-guided biopsy vs standard brush cytology in patients with and without primary sclerosing cholangitis(PSC).METHODS: At the University Medical Center Mainz, Germany, 35 consecutive patients with unclear biliarylesions(16 patients) or long-standing PSC(19 patients) were screened for the study. All patients underwent a physical examination, lab analyses, and abdominal ultrasound. Thirty-one patients with non-PSC strictures or with PSC were scheduled to undergo endoscopic retrograde cholangiography(ERC) and subsequent per-oral cholangioscopy(POC). Standard ERC was initially performed, and any lesions or strictures were localized. POC was performed later during the same session. The Boston Scientific SpyGlass SystemTM(Natick, MA, United States) was used for choledochoscopy. The biliary tree was visualized, and suspected lesions or strictures were biopsied, followed by brush cytology of the same area. The study endpoints(for both techniques) were the degree of inflammation, tissue specimen size, and the patient populations(PSC vs non-PSC). Inflammatory changes were divided into three categories: none, low activity, and high activity. The specimen quantity was rated as low, moderate, or sufficient.RESULTS: SpyGlassTM imaging and brush cytology with material retrieval were performed in 29 of 31(93.5%) patients(23 of the 29 patients were male). The median patient age was 45 years(min, 20 years; max, 76 years). Nineteen patients had known PSC, and 10 showed non-PSC strictures. No procedure-related complications were encountered. However, for both methods, tissues could only be retrieved from 29 pa-tients. In cases of inflammation of the biliary tract, the diagnostic yield of the SpyGlassTM-directed biopsies was greater than that using brush cytology. More tissue material was obtained for the biopsy method than for the brush cytology method(P = 0.021). The biopsies showed significantly more inflammatory characteristics and greater inflammatory activity compared to the cy-tological investigation(P = 0.014). The greater quantity of tissue samples proved useful for both PSC and non-PSC patients.CONCLUSION: SpyGlassTM imaging can be recom-mended for proper inflammatory diagnosis in PSC pa-tients. However, its value in diagnosing dysplasia wasnot addressed in this study and requires further investi-gation.
文摘AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)and 19 with systemic sclerosis(SSc)were prospectively selected from a total of 115patients at a single university centre and esophageal motility was analysed using standard manometry(Mui Scientific PIP-4-8SS).All patients underwent esophagogastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study.All patients underwent a complete physical,blood biochemistry and urinary examination.The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms.Furthermore,disease activity scores(SLEDAI and modified Rodnan score)were obtained for patients with autoimmune diseases.Outcome parameter:A correlation coefficient was calculated between amplitudes,velocity and duration of the peristaltic waves throughout esophagus and patients’dysphagia for all three groups.RESULTS:There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups.Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc.The mean value of dysphagia score was in IBS group 7.3,in SLE group 6.73 and in SSc group7.56 with a P-value>0.05.However,the manometric patterns were different.IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in46%of the patients,which was significant higher in comparison to the SLE(11.8%)and SSc-Group(0%,P=0.003).Furthermore,IBS patients showed lower mean resting pressure of the distal esophagus sphincter(Lower esophageal sphincter,22 mmHg)when compared with SLE(28 mmHg,P=0.037)and SSc(26 mmHg,P=0.052).23.5%of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus(IBS and SSc:0%)whereas 29.4%amplitudes greater as 100 mmHg in the middle one(IBS:16.7%,SSc:5.9%respectively,P=0.006).Patients with SSc demonstrated,as expected,in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus.SSc patients demonstrated a negative correlation coefficient between dysphagia score,amplitude and velocity of peristaltic activity at middle and lower esophagus[r=-0.6,P<CONCLUSION:IBS patients have comparable dysphagia-scores as patients with autoimmune disorders.The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.
文摘AIM: To investigate the impact of Jet Prep cleansing on adenoma detection rates.METHODS: In this prospective,randomized,crossover trial,patients were blindly randomized to an intervention arm or a control arm.In accordance with the risk profile for the development of colorectal carcinoma,the study participants were divided into high-risk and low-risk groups.Individuals with just one criterion(age > 70 years,adenoma in medical history,and first-degree relative with colorectal cancer) were regarded as high-risk patients.Bowel preparation was performed in a standardized manner one day before the procedure.Participants in the intervention arm underwent an initial colonoscopy with standard bowel cleansing using a 250-m L syringe followed by a second colonoscopy that included irrigation by the use of the Jet Prep cleansing system.The reverse sequence was used in the control arm.The study participants were divided into a high-risk group and a low-risk group according to their respective risk profiles for the development of colorectal carcinoma.RESULTS: A total of 64 patients(34 men and 30 women) were included in the study; 22 were included in the high-risk group.After randomization,30 patients were assigned to the control group(group A) and 34 to the intervention group(group B).The average Boston Bowel Preparation Scale score was 5.15 ± 2.04.The withdrawal time needed for the first step was significantly longer in group A using the Jet Prep system(9.41 ± 3.34 min) compared to group B(7.5 ± 1.92 min).A total of 163 polyps were discovered in 64 study participants who underwent both investigation steps.In group A,49.4% of the polyps were detected during the step of standard bowel cleansing while the miss rate constituted 50.7%.Group B underwent cleansing with the Jet Prep system during the first examination step,and as many as 73.9% of polyps were identified during this step.Thus,the miss rate in group B was a mere 26.1%(P < 0.001).When considering only the right side of the colon,the miss rate in group A during the first examination was 60.6%,in contrast to a miss rate of 26.4% in group B(P < 0.001).CONCLUSION: Jet Prep is recommended for use during colonoscopy because a better prepared bowel enables a better adenoma detection,particularly in the proximal colon.
