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Updated: Mar 8, 2026
Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique
Published on: January 10, 2013
Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy
Masakuni Kobayashi1, Kazuki Sumiyama2, Naoki Shimojima3,4
1Department of Endoscopy and Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Background And Aim:
In preceding studies, we identified that the myenteric plexus (MP) could be visualized with confocal laser endomicroscopy (CLE) by applying neural fluorescent probes lacking clinical safety profiling data from the submucosal side. In this study, we evaluated the technical feasibility of MP visualization using probe-based CLE (pCLE) from the serosal side with cresyl violet (CV), which has been used clinically for chromoendoscopy.
Methods:
The dye affinity of CV for MP was first explored in an in vivo transgenic mouse model using neural crest derivatives labeled with green fluorescent protein. We also tested the feasibility of CV-assisted visualization of MP in human surgical specimens, wherein the tissue dying and pCLE observation were performed from the serosal side. In the human study, rate of MP visualization by pCLE was evaluated as the primary outcome. We also evaluated the sensitivity and specificity of MP visualization by pCLE, using pathological presence/absence of MP as the gold standard.
Results:
We confirmed the dye affinity of CV to MP in all tested models. The MP appeared as brightly stained ladder-like structures with pCLE, and in the human study, MP was visualized in 12/14 (85.7%) samples, with 92.3% sensitivity and 100% specificity. In positive cases showing the ladder-like structure of MP by pCLE, the mean maximum and minimum widths of nerve strands were 54.3 (± 23.6) and 19.7 (± 6.0) μm, respectively. A ganglion was detected by pCLE in 10 cases (10/12, 83.3%).
Conclusions:
This study demonstrated the technical feasibility of visualizing the MP in real time by CV-assisted pCLE (UMIN-CTR number, UMIN000015056).
Insights
This study shows that cresyl violet (CV) can be safely used with probe-based confocal laser endomicroscopy (pCLE) for visualizing the myenteric plexus (MP) from the serosal side in human surgical specimens.
Area of Science:
- Gastroenterology
- Surgical Endoscopy
- Neuroscience
Background:
- Previous myenteric plexus (MP) visualization using confocal laser endomicroscopy (CLE) relied on neural probes without established clinical safety.
- Visualization was previously performed from the submucosal side.
Purpose of the Study:
- To evaluate the technical feasibility of visualizing the MP from the serosal side using probe-based CLE (pCLE) with cresyl violet (CV).
- To assess the safety and efficacy of CV for MP visualization in human surgical specimens.
Main Methods:
- Explored CV dye affinity for MP in a transgenic mouse model.
- Assessed CV-assisted pCLE visualization of MP in human surgical specimens from the serosal side.
- Evaluated visualization rate, sensitivity, and specificity against pathological standards.
Main Results:
- Confirmed CV dye affinity for MP in all models.
- MP visualized in 85.7% of human samples via CV-assisted pCLE with high sensitivity (92.3%) and specificity (100%).
- pCLE identified ladder-like nerve structures and ganglia, with mean nerve strand widths of 54.3 μm (max) and 19.7 μm (min).
Conclusions:
- Demonstrated the technical feasibility of real-time MP visualization using CV-assisted pCLE from the serosal side.
- CV is a viable and safe option for intraoperative MP assessment.
