Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy.
OBJECTIVE
Confocal laser endomicroscopy enables subsurface microscopic imaging of living tissue during ongoing endoscopy. This case report describes the in vivo detection of Helicobacter pylori by endomicroscopy.


METHODS
Endomicroscopy (Pentax, Tokyo, EC-3870CIFK) was performed by using two different contrast stains: Topical Acriflavine in addition to intravenously applied fluorescein netted the surface and allowed identification of focal accumulation of Helicobacter pylori at the surface and in deeper layer of the gastric epithelium. Biopsies were performed at the antrum and corpus for urease testing and histology. In addition, biopsies were cultured for Helicobacter pylori. Cultured bacteria were re-assessed ex vivo using confocal microscopy with and without acriflavine staining.


RESULTS
Helicobacter pylori infection could be detected in a 70-year-old male by endomicroscopy. Accumulated, as well as single bacteria, could be observed and the distinct shape and flagella of Helicobacter pylori could be identified. Helicobacter pylori infection was proved by histology. Furthermore, ex vivo examination of cultures proved the presence of Helicobacter pylori and the active uptake of acriflavine into the bacteria.


CONCLUSIONS
Endomicroscopy is a new diagnostic approach, which enables the immediate diagnosis of Helicobacter pylori in vivo during standard video endoscopy.
Kiesslich
Ralf
R
I. Medical Clinic, Johannes Gutenberg University of Mainz, Germany.
Goetz
Martin
M
Burg
Juergen
J
Stolte
Manfred
M
Siegel
Ekkehard
E
Maeurer
Markus J
MJ
Thomas
Steven
S
Strand
Dennis
D
Galle
Peter R
PR
Neurath
Markus F
MF
D000167:Acriflavine; D000287:Administration, Topical; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019793:Fluorescein; D005456:Fluorescent Dyes; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D012680:Sensitivity and Specificity
D003287:Contrast Media; D005456:Fluorescent Dyes; D000167:Acriflavine; D019793:Fluorescein