title: Confocal laser endomicroscopy in ulcerative colitis: a longitudinal study of endomicroscopic changes and response to medical therapy (with videos).
abstract: OBJECTIVE
  Confocal laser endomicroscopy enables real-time in vivo microscopy during endoscopy and can predict relapse in patients with inflammatory bowel disease in remission. However, little is known about how endomicroscopic features change with time. The aim of this longitudinal study was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment.
  
  
  METHODS
  Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were enrolled. The colonic mucosa was examined with high-definition colonoscopy, histopathology, and CLE at 4 colonic sites. Subsequently, patients requiring medical treatment escalation were referred for repeat endoscopy with CLE after 6 to 8 weeks.
  
  
  RESULTS
  The baseline frequency of fluorescein leakage (P < .001), microerosions (P < .001), tortuosity of the crypts (P = .001), distortion of the crypts openings (P = .001), presence of inflammatory infiltrates (P < .001), and decreased crypt density (P < .001) were significantly higher in active ulcerative colitis compared with inactive ulcerative colitis and control subjects. A decrease in histopathologic score after medical treatment escalation was correlated with improvement in crypt tortuosity (rs = .35, P = .016), distortion of crypt openings (rs = .30, P = .045), and decreased crypt density (rs = .33, P = .026) but not in other features.
  
  
  CONCLUSIONS
  CLE is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. (
  
  
  BACKGROUND
  NCT01684514.).
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: John Gásdal
authors.initials: JG
authors.lastname: Karstensen
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Săftoiu
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Jørn
authors.initials: J
authors.lastname: Brynskov
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Hendel
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark; Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: Adriana
authors.initials: A
authors.lastname: Ciocalteu
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Klausen
authors.affiliation: Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Tobias Wirenfeldt
authors.initials: TW
authors.lastname: Klausen
authors.affiliation: Department of Pathology, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Lene Buhl
authors.initials: LB
authors.lastname: Riis
authors.affiliation: Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vilmann
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000473:pathology*; D003113:Colonoscopy; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000473:pathology*; D000069416:Intravital Microscopy; D008137:Longitudinal Studies; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D018613:Microscopy, Confocal; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005456:Fluorescent Dyes; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D019804:Mesalamine; D000069285:Infliximab; D001379:Azathioprine; D019793:Fluorescein