title: A Pilot Study of Confocal Laser Endomicroscopy to Predict Barrier Dysfunction and Relapse in Pediatric Inflammatory Bowel Disease.
abstract: Probe-based confocal laser endomicroscopy (pCLE) is a novel imaging modality that enables virtual optical biopsy in vivo. Loss of barrier function of the small bowel observed via pCLE as increased density of epithelial gaps (extrusion zones left in the intestinal lining after cells are shed) is predictive of relapse in adult patients with inflammatory bowel disease (IBD). This study aims to determine whether such observations on pCLE are similarly predictive of disease relapse in pediatric patients with IBD.
  
  
  
  Pediatric patients with biopsy-proven IBD underwent pCLE during colonoscopy and subsequent clinical follow-up every 6 months. Relapse was defined as moderate to severe flare with endoscopic evidence of inflammation during the follow-up period. The relations between epithelial gap density, disease relapse, and imaging parameters were determined using Cox models.
  
  
  
  Twenty-four patients with IBD (13 with Crohn disease, 11 with ulcerative colitis) with a median age of 14 years (range 10-21) were studied for a median of 13 (4-33) months. The median duration of disease was 2.9 years (range 0-9). Increased epithelial gap density in the terminal ileum on pCLE of normal endoscopic appearing terminal ileum mucosa (N = 19) was predictive of disease relapse when 3 or more areas were imaged (N = 6, log-rank P = 0.02, C-statistic = 0.94).
  
  
  
  In pediatric patients with IBD, barrier dysfunction observed on pCLE imaging of the small bowel was predictive of disease relapse.
authors.affiliation: *Endoscopy Department, The Scientific Center of Children's Health, Russian Academy of Medical Sciences (RAMS)†Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russian Federation‡Division of Gastroenterology, University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock§Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA||Institute of Pediatric Surgery Department, The Scientific Center of Children's Health, Russian Academy of Medical Sciences (RAMS), Moscow, Russian Federation.
authors.forename: Anton
authors.initials: A
authors.lastname: Shavrov
authors.forename: Anastasia Y
authors.initials: AY
authors.lastname: Kharitonova
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: Davis
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.forename: Dmitriy A
authors.initials: DA
authors.lastname: Morozov
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Brown
authors.forename: Andrey A
authors.initials: AA
authors.lastname: Shavrov
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D002648:Child; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal; D010865:Pilot Projects; D012008:Recurrence; D055815:Young Adult