title: Real-time in vivo imaging of early mucosal changes during ischemia-reperfusion in human jejunum.
abstract: OBJECTIVE
  Small intestinal ischemia-reperfusion (IR) is a frequent, potentially life threatening phenomenon. There is a lack of non-invasive diagnostic modalities. For many intestinal diseases, visualizing the intestinal mucosa using endoscopy is gold standard. However, limited knowledge exists on small intestinal IR-induced, early mucosal changes. The aims of this study were to investigate endoscopic changes in human jejunum exposed to IR, and to study concordance between endoscopic appearance and histology.
  
  
  METHODS
  In 23 patients a part of jejunum, to be removed for surgical reasons, was isolated and selectively exposed to ischemia with 0, 30 or 120 minutes of reperfusion. In 3 patients, a videocapsule was inserted in the isolated segment before exposure to IR, to visualize the mucosa. Endoscopic view at several time points was related to histology (Heamatoxylin & Eosin) obtained from 20 patients.
  
  
  RESULTS
  Ischemia was characterized by loss of villous structure, mucosal whitening and appearance of punctate lesions. This was related to appearance of subepithelial spaces and breaches in the epithelial lining in the histological view. Early during reperfusion, the lumen filled with IR-damaged, shed cells and VCE showed mucosal erosions, hemorrhage and intraluminal debris. At 60 minutes of reperfusion, the only remaining signs of IR were loss of villous structure and small erosions, indicating rapid mucosal healing.
  
  
  CONCLUSIONS
  This study shows a unique, real-time in vivo endoscopic view of early mucosal changes during IR of the human small intestine. Future studies should evaluate its usefulness in diagnosis of patients suspected of IR.
authors: Department of Surgery, NUTRIM School for Nutrition, Toxicology & Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Joep
authors: J
authors: Grootjans
authors: Wim
authors: W
authors: Hameeteman
authors: Ad A
authors: AA
authors: Masclee
authors: Ronald M
authors: RM
authors: van Dam
authors: Wim A
authors: WA
authors: Buurman
authors: Cornelis H C
authors: CH
authors: Dejong
mesh_terms: D004724:Endoscopy; D006801:Humans; D066298:In Vitro Techniques; D007413:Intestinal Mucosa / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D007583:Jejunum / Q000473:pathology*; D015427:Reperfusion Injury / Q000473:pathology*