A new method in the diagnosis of reflux esophagitis: confocal laser endomicroscopy.
BACKGROUND
The diagnosis of GERD is made by using a combination of clinical symptoms, pH study, endoscopy, and histology. Histologic changes include basal cell hyperplasia and papillary elongation. Confocal laser endomicroscopy (CLE) enables surface and subsurface imaging of living cells in vivo at ×1000 magnification and up to 250 μm below the tissue surface. In the esophagus, the distance between the surface to papillary (S-P) tip can be measured by using CLE.


OBJECTIVE
To measure the S-P distance in the esophagus in patients with reflux esophagitis and controls by using CLE and comparing with histologic measurements.


METHODS
Retrospective analysis of a prospective database.


METHODS
Endoscopy unit of a tertiary-care children's hospital.


METHODS
This study involved 7 patients (5 female) with a median age of 7.6 years (range 1.8-15.5 years) and median weight of 23 kg (range 13.2-71 kg) and 16 controls with a median age of 12.0 years (range 2.2-15.3 years) and median weight of 38.2 kg (range 10.7-83 kg).


METHODS
S-P distance was measured both by CLE and histology and was corrected for height for both patients and controls and the results compared.


METHODS
To determine if there were significant differences in the S-P distance in patients with esophagitis and controls.


RESULTS
The median confocal and histologic measurements for S-P distance, corrected for patient height, were 0.19 μm/cm (range 0.10-0.49 μm/cm) and 0.58 μm/cm (range 0.29-0.76 μm/cm) and for controls were 0.44 μm/cm (range 0.20-0.93 μm/cm) and 1.07 μm/cm (range 0.76-0.1.57 μm/cm), respectively.


CONCLUSIONS
Small numbers involved in the study, reliance on only papillary elongation in arriving at a diagnosis.


CONCLUSIONS
Measurement of the S-P distance by CLE will enable real-time diagnosis of GERD-related esophagitis during ongoing endoscopy.
Centre for Pediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
Krishnappa
K
Venkatesh
Marta
M
Cohen
Ashraf
A
Abou-Taleb
Steven
S
Thomas
Christopher
C
Taylor
Mike
M
Thomson
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D018613:Microscopy, Confocal; D009092:Mucous Membrane / Q000473:pathology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric