title: Confocal laser endomicroscopy for the detection of mucosal changes in ileal pouch after restorative proctocolectomy.
abstract: BACKGROUND
  Pouchitis and dysplasia may affect the reservoir after restorative proctocolectomy.
  
  
  OBJECTIVE
  To assess the suitability of confocal laser endomicroscopy for the in vivo diagnosis of mucosal changes in ileal pouch for ulcerative colitis and familial adenomatous polyposis.
  
  
  METHODS
  Standard endoscopy and endomicroscopy were performed in 18 pouches. Confocal images were scored for the presence of villous atrophy, inflammation, ulceration, colonic metaplasia and dysplasia. Targeted biopsies were taken. Endomicroscopic and histological findings were compared.
  
  
  RESULTS
  At standard endoscopy, the signs of pouchitis were recorded in 7/18 (38.9%) patients. At endomicroscopy, pathological features were found in 16/18 (88.9%), villous atrophy in 15/18 (83.3%), inflammation in 13/18 (72.2%), ulceration in 3/18 (16.7%), and colonic metaplasia in 12/18 (67.7%). No dysplasia was observed. At histology, abnormalities were present in 17/18 (94.4%): villous atrophy in 15/18 (83.3%), inflammation in 17/18 (94.4%), ulceration in 6/18 (33.3%), colonic metaplasia in 15/18 (83.3%). Morphological changes of the ileal pouch could be predicted with an accuracy of 94.4% (95% CI: 74.2-99.0). The k-value for intra- and interobserver agreement was 0.93 and 0.78, respectively.
  
  
  CONCLUSIONS
  Endomicroscopy may be helpful in the evaluation of morphologic changes in ileal pouch. The small size of the population sample requires further studies for the results to be confirmed.
authors.affiliation: Division of Endoscopy, European Institute of Oncology, Via Ripamonti 435 - 20141 Milan, Italy. cristina.trovato@ieo.it
authors.forename: C
authors.initials: C
authors.lastname: Trovato
authors.forename: A
authors.initials: A
authors.lastname: Sonzogni
authors.forename: G
authors.initials: G
authors.lastname: Fiori
authors.forename: D
authors.initials: D
authors.lastname: Ravizza
authors.forename: D
authors.initials: D
authors.lastname: Tamayo
authors.forename: F
authors.initials: F
authors.lastname: Botti
authors.forename: A
authors.initials: A
authors.lastname: Carrara
authors.forename: A
authors.initials: A
authors.lastname: Zefelippo
authors.forename: E
authors.initials: E
authors.lastname: Contessini-Avesani
authors.forename: C
authors.initials: C
authors.lastname: Crosta
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D055815:Young Adult