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Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique
Published on: January 10, 2013
Imbalanced mucosal microcirculation in the remission stage of ulcerative colitis using probe-based confocal laser
Yu Tian1, Yue Zheng1, Guigen Teng1
1Gastroenterology Department of Peking University First Hospital, Beijing, China.
Insights
Confocal Laser Endomicroscopy revealed altered colonic microcirculation in ulcerative colitis (UC) patients. Decreased capillary density and distinct blood flow patterns in UC indicate potential for monitoring disease activity and healing.
Area of Science:
- Gastroenterology and Hepatology
- Medical Imaging
- Microcirculation Research
Background:
- Microcirculatory disturbances are implicated in Inflammatory Bowel Disease (IBD) pathogenesis.
- Confocal Laser Endomicroscopy (CLE) enables in-vivo visualization of colonic mucosal microcirculation.
- Limited studies have explored microcirculatory changes in IBD using advanced imaging.
Purpose of the Study:
- To investigate and compare colonic microcirculation parameters between ulcerative colitis (UC) patients in remission and healthy controls.
- To analyze the relationship between specific microcirculatory blood flow patterns and disease recurrence in UC patients.
- To assess the utility of probe-based Confocal Laser Endomicroscopy (pCLE) in evaluating mucosal healing indicators.
Main Methods:
- Retrospective analysis of 7 UC patients in clinical remission and 7 healthy subjects undergoing pCLE (2014-2016).
- pCLE examination of ascending, transverse/descending, and sigmoid colon segments.
- Quantification of Mean Vessel Diameter (MVD), Diameter Standard Deviation (DSD), Functional Capillary Density-long (FCDL), and Functional Capillary Density-area (FCDA) using specialized software.
- Classification of blood flow patterns into Around (A), Cobweb (C), and Deficiency (D) types for correlation with recurrence.
Main Results:
- UC patients exhibited significantly increased DSD and decreased FCDA compared to healthy subjects (P < 0.01).
- No significant differences were observed in MVD and FCDL between the groups.
- Healthy subjects showed Type A (66.67%) and Type C (33.33%) blood flow; UC patients predominantly showed Type C (71.3%) and Type D (14.29%) (P < 0.01).
- Type D blood flow was associated with a shorter recurrence interval in UC patients.
Conclusions:
- Local mucosal capillary density is reduced in UC patients, particularly in inflamed segments.
- The identified mucosal blood flow patterns (A, C, D) serve as potential indicators of mucosal healing in UC.
- pCLE offers valuable insights into microcirculatory alterations relevant to UC pathogenesis and monitoring.
Background:
Microcirculatory disturbance is an important factor in the pathogenesis of Inflammatory Bowel Disease (IBD) but there have been few studies in this field. Confocal Laser Endomicroscopy (CLE) has been used over the last 10 years and has made it possible to explore the changes in microcirculation of the colonic mucosa.
Methods:
We retrospectively selected patients who underwent probe-based Confocal Laser Endomicroscopy (pCLE) between 2014 and 2016. There were 7 patients with ulcerative colitis (UC) in clinical remission and 7 healthy subjects included in this study; all the UC patients' medical data were reviewed. For each patient, three segments of the colon were examined using pCLE including the ascending, transverse/descending and sigmoid colon. In each segment, the representative pCLE images of the three sites were selected for analysis. Four indicators, including Mean Vessel Diameter (MVD), Diameter Standard Deviation (DSD), Functional Capillary Density-long (FCDL) and Functional Capillary Density-area (FCDA), were measured with a specially designed detection software algorithm. The four indicators were compared between UC patients and healthy subjects. According to the different blood flow patterns, three types of distribution were established: the Around (A), Cobweb (C) and Deficiency (D) type. The relationships between the recurrence and blood flow patterns of UC patients were analyzed.
Results:
MVD, DSD, FCDL and FCDA were 10.62 ± 0.56 μm, 2.23 ± 0.26, 0.030 ± 0.019 μm and 0.289 ± 0.030 for the healthy subjects and 11.06 ± 1.10 μm, 2.68 ± 0.29, 0.026 ± 0.005 μm and 0.272 ± 0.034 for the UC patients, respectively. Compared with healthy subjects, DSD was significantly increased and FCDA was significantly decreased (P < 0.01 for both). There was no difference in MVD and FCDL between UC patients and healthy subjects. The type A and type C blood flows were observed in healthy subjects (66.67 and 33.33%, respectively) while type C appears more in UC patients (71.3%) and type D blood flow could only be found in UC patients (14.29%) P < 0.01. UC patients who showed Type D blood flow had a shorter recurrence interval.
Conclusions:
Some local mucosal capillary density in UC patients was decreased, particularly in the inflammation-affected segment. The three mucosal blood flow patterns can be used as an indicator of mucosal healing.
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