Stand der Technik und klinische Anwendungen der konfokalen Laser-Endomikroskopie

Zusammenfassung

Seit ihrer Einführung im Jahr 2003 hat sich die konfokale Laser-Endomikroskopie (CLE) zu einem wertvollen Instrument in der gastrointestinalen Bildgebung entwickelt. Die CLE erlaubt die Gewinnung einer In-vivo-Histologie während der endoskopischen Untersuchung. Bis zum gegenwärtigen Zeitpunkt konnte in zahlreichen Studien das Potenzial der CLE unter anderem für die In-vivo-Diagnostik des Barrett-Ösophagus und der Zöliakie sowie für die Identifikation einzelner Bakterienspezies gezeigt werden. Weitere Studien zur CLE belegen das Potenzial für die Diagnose von chronisch-entzündlichen Darmerkrankungen sowie von kolorektalen Polypen. Im Weiteren ermöglicht die CLE unter Verwendung fluoreszenzmarkierter Anti­kör­per die sogenannte „molekulare Bildgebung“. Dieser Überblick fasst die technischen Aspekte zur CLE sowie wesentliche klinische Studien für die In-vivo-Diagnostik gastrointestinaler Er­krankungen zusammen und gibt einen Ausblick auf zukünftige Entwicklungen im Bereich der konfokalen Bildgebung.

Abstract

Since 2003, confocal laser endomicroscopy (CLE) has emerged as a valuable tool for gastrointestinal endoscopic imaging. CLE enables obtainment of in vivo histology during ongoing endoscopy in real time. To date, numerous studies have shown various applications of CLE, including in vivo diagnosis of Barrett’s esophagus, celiac disease, bacterial infections, CED and colonic polyps. Moreover, recent data suggest the potential application of endomicroscopy in the field of molecular imaging. Additionally, new applications and developments in the field of confocal imaging were introduced including CLE of the liver, pancreatic, and bile ducts. This review focuses on the technical aspects of CLE and potential clinical applications.

Schlüsselwörter

Endomikroskopie - i-scan - NBI - FICE - Molekulare Bildgebung

Key words

endomicroscopy - i-scan - NBI - FICE - molecular imaging

• Literatur

• 1 Neumann H, Kiesslich R, Wallace MB et al. Confocal laser endomicroscopy: technical advances and clinical applications. Gastroenterology 2010; 139: 388-392
• 2 Wallace MB, Meining A, Canto MI et al. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharmacol Ther 2010; 31: 548-552
• 3 Neumann H, Vieth M, Atreya R et al. Prospective evaluation of the learning curve of confocal laser endomicroscopy in patients with IBD. Histol Histopathol 2011; 26: 867-872
• 4 Neumann H, Vieth M, Atreya R et al. First description of eosinophilic esophagitis using confocal laser endomicroscopy (with video). Endoscopy 2011; 43: 66
• 5 Pech O, Rabenstein T, Manner H et al. Confocal laser endomicroscopy for in vivo diagnosis of early squamous cell carcinoma in the esophagus. Clin Gastroenterol Hepatol 2008; 6: 89-94
• 6 Liu H, Li YQ, Yu T et al. Confocal laser endomicroscopy for superficial esophageal squamous cell carcinoma. Endoscopy 2009; 41: 99-106
• 7 Kiesslich R, Gossner L, Goetz M et al. In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol 2006; 4: 979-987
• 8 Sharma P, Meining AR, Coron E et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011; 74: 465-472
• 9 Neumann H, Langner C, Neurath MF et al. Confocal Laser Endomicroscopy for Diagnosis of Barrett’s Esophagus. Front Oncol 2012; 2: 42
• 10 Kiesslich R, Goetz M, Burg J et al. Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy. Gastroenterology 2005; 128: 2119-2123
• 11 Ji R, Li YQ, Gu XM et al. Confocal laser endomicroscopy for diagnosis of Helicobacter pylori infection: a prospective study. J Gastroenterol Hepatol 2010; 25: 700-705
• 12 Guo YT, Li YQ, Yu T et al. Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study. Endoscopy 2008; 40: 547-553
• 13 Zhang JN, Li YQ, Zhao YA et al. Classification of gastric pit patterns by confocal endomicroscopy. Gastrointest Endosc 2008; 67: 843-853
• 14 Neumann H, Vieth M, Raithel M et al. Confocal laser endomicroscopy for the in vivo detection of intraepithelial neoplasia in Peutz-Jeghers polyps. Endoscopy 2010; 42: 139-140
• 15 Li WB, Zuo XL, Li CQ et al. Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions. Gut 2011; 60: 299-306
• 16 Buchner AM, Shahid MW, Heckman MG et al. Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps. Gastroenterology 2010; 138: 834-842
• 17 Neumann H, Grauer M, Vieth M et al. In vivo diagnosis of lymphocytic colitis by confocal laser endomicroscopy. Gut 31.07.2012; [Epub ahead of print]
• 18 Zambelli A, Villanacci V, Buscarini E et al. Collagenous colitis: a case series with confocal laser microscopy and histology correlation. Endoscopy 2008; 40: 606-608
• 19 Li CQ, Xie XJ, Yu T et al. Classification of inflammation activity in ulcerative colitis by confocal laser endomicroscopy. Am J Gastroenterol 2010; 105: 1391-1396
• 20 Neumann H, Vieth M, Atreya R et al. Assessment of Crohn’s disease activity by confocal laser endomicroscopy. Inflamm Bowel Dis 16.02.2012;
• 21 Kiesslich R, Goetz M, Lammersdorf K et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007; 132: 874-882
• 22 Kiesslich R, Duckworth CA, Moussata D et al. Local barrier dysfunction identified by confocal laser endomicroscopy predicts relapse in inflammatory bowel disease. Gut 2012; 61: 1146-1153
• 23 Hsiung PL, Hardy J, Friedland S et al. Detection of colonic dysplasia in vivo using a targeted heptapeptide and confocal microendoscopy. Nat Med 2008; 14: 454-458
• 24 Foersch S, Kiesslich R, Waldner MJ et al. Molecular imaging of VEGF in gastrointestinal cancer in vivo using confocal laser endomicroscopy. Gut 2010; 59: 1046-1055
• 25 Hoetker MS, Kiesslich R, Diken M et al. Molecular in vivo imaging of gastric cancer in a human-murine xenograft model: targeting epidermal growth factor receptor. Gastrointest Endosc 2012; 76: 612-620