Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders.
OBJECTIVE
To evaluate the feasibility and utility of confocal laser endomicroscopy (CLE) in the description of normal gastrointestinal (GI) mucosa and in the diagnosis of GI disorders in children, in comparison to histology.


METHODS
Forty-four patients (19 female) median age 10.9 years (range 0.7-16.6 years) with suspected or known GI pathology underwent esophago-gastro-duodenoscopy (OGD) (n = 36) and/or ileocolonoscopy (IC) (n = 31) with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively.


RESULTS
Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min (range 7-25 min) for OGD and 27.9 min (range 15-45 min) for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures. Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease.


CONCLUSIONS
CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.
Centre for Pediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, United Kingdom.
Krishnappa
K
Venkatesh
Marta
M
Cohen
Clair
C
Evans
Peter
P
Delaney
Steven
S
Thomas
Christopher
C
Taylor
Ashraf
A
Abou-Taleb
Ralf
R
Kiesslich
Mike
M
Thomson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019723:Endoscopes; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D041981:Gastrointestinal Tract / Q000473:pathology; D006801:Humans; D007223:Infant; D007834:Lasers; D018613:Microscopy, Confocal / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data*