Probe-based confocal laser endomicroscopy in double balloon enteroscopy.

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Imaging

Background:

• Probe-based confocal laser endomicroscopy (pCLE) enables in-vivo assessment of gastrointestinal mucosal architecture.
• Double balloon enteroscopy (DBE) allows deep insertion into the small bowel.
• The combination of pCLE with DBE for deep small bowel examination has not been previously investigated.

Purpose of the Study:

• To investigate the feasibility and safety of performing pCLE during DBE.
• To assess the technical success rate of pCLE in the deep small bowel.
• To evaluate the safety profile of the combined pCLE-DBE procedure.

Main Methods:

• DBE was performed using the Fujinon EN-450P5 system.
• pCLE was conducted using a 1.8-mm probe (Cellvizio-GI®) after fluorescein injection.
• Technical success was defined by successful probe advancement and imaging; safety was monitored for adverse events.

Main Results:

• 27 DBE procedures were performed in 16 patients, reaching mean small bowel insertion depths of 255 cm (antegrade) and 130 cm (retrograde).
• Technical success for pCLE was high at 96.3% (antegrade 92.8%, retrograde 100%), with one instance of incomplete probe advancement.
• No adverse events related to pCLE were reported, and small bowel mucosal architecture, including pathological findings, was visualized in all successful procedures.

Conclusions:

• This study demonstrates the first successful and safe application of pCLE in the deep small bowel via DBE.
• pCLE during DBE allows for in-vivo visualization of small bowel mucosal architecture and pathology.
• Further research is warranted to establish the clinical utility of pCLE in managing small bowel diseases.