title: Probe-based confocal laser endomicroscopy quantitative morphometric markers associated with portal hypertension in duodenal mucosa.
abstract: OBJECTIVE
  Early detection of portal hypertension (PH) may help to prevent the morbidity of late-stage cirrhosis by stratifying disease severity and enabling disease-modifying interventions in potentially reversible conditions like non-alcoholic fatty liver disease and alcoholic hepatitis. This study seeks to correlate morphometric features by confocal endomicroscopy with established surrogate clinical markers of PH.
  
  
  METHODS
  Patients with and without PH scheduled for upper endoscopy at VA Boston participated in this IRB-approved study. Real-time probe-based confocal endomicroscopy (pCLE) was performed in the duodenum. Vascular and epithelial morphometry was performed off-line, in a blinded manner, using image-processing software.
  
  
  RESULTS
  Morphometric analysis of pCLE images from 16 patients with PH and 15 control patients was performed. Statistically significant differences were observed among control and PH patients for average vessel diameter (AVD: 11.7 μm vs. 17.1 μm), average vessel branching (AVB: 0.11 vs. 0.31 bifurcations per image frame), and average columnar cell height (ACCH: 40.0 μm vs. 52.0 μm). Spearman correlations comparing AVD, AVB and ACCH to portal gastropathy scores (0.86, 0.44 and 0.70) and to grade of oesophageal varices (0.88, 0.41 and 0.66) were statistically significant. Similarly, Pearson correlations of AVD and ACCH to spleen size (0.72 and 0.57), platelet count (-0.69 and -0.40) and the platelet count/spleen size ratio (-0.69 and -0.41) were also found to be statistically significant.
  
  
  CONCLUSIONS
  Duodenal pCLE reveals microvascular dilatation and altered epithelial cell volume/morphology in PH. These morphometric pCLE markers correlate with surrogate markers of PH. Additional studies will define the correlation between microscopic vascular patterns, epithelial cell volume and the hepatic venous pressure gradient.
authors.affiliation: Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA.|Section of Gastroenterology, VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Eladio
authors.initials: E
authors.lastname: Rodriguez-Diaz
authors.affiliation: Section of Gastroenterology, VA Boston Healthcare System, Boston, MA, USA.|Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: György
authors.initials: G
authors.lastname: Baffy
authors.affiliation: Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA.|Section of Gastroenterology, VA Boston Healthcare System, Boston, MA, USA.|Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.|Department of Biomedical Engineering, College of Engineering, Boston University, Boston, MA, USA.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Singh
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D004384:Duodenoscopy / Q000379:methods; D004386:Duodenum / Q000473:pathology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D013223:Statistics as Topic
chemical_list: D015415:Biomarkers
keywords: confocal laser endomicroscopy; endoscopy; portal hypertension