Initial Experience With Confocal Laser Endomicroscopy In The Pre-operative Assessment Of Bariatric Patients

Aliyah Kanji, MD, Luke Funk, MD, MPH, Dean J Mikami, MD, FACS

The Ohio State University Wexner Medical Center

Background

Probe-based confocal laser endomicroscopy (pCLE) allows for real time assessment of esophageal and gastric mucosa at the time of initial endoscopy. Developed by Mauna Kea Technology, this confocal miniprobe can be passed into the working channel of any standard adult gastroscope. A high speed laser scanning unit allows for high definition processing of images in real time. The optical slicing capability is analogous to the processing of biopsies for histology, which allows for in vivo dynamic visualization of cellular and vascular elements of mucosal tissue.

Methods

Endoscopy was performed in 7 patients undergoing pre-operative screening for consideration of bariatric surgery. A standard Olympus adult gastroscope was used in all cases. pCLE (Cellvizio-GI®, Mauna Kea Technologies) was performed after intravenous injection of 5 cc of fluorescein (10% concentration). Esophageal biopsies were obtained if any esophageal abnormalities were identified. Gastric biopsies were obtained in all patients to assess for the presence of H. pylori. Endoscopic findings and pCLE findings were recorded and compared to the pathologic diagnosis.

Preliminary results

The average age of our population was 42.7 years of age. There were 6 females and 1 male. All patients had experienced heartburn and reflux symptoms. Endoscopic findings revealed esophagitis in 6/7 patients. pCLE imaging showed evidence of mucosal changes suggestive of reflux esophagitis in 5/7 patients. Pathologic evaluation revealed evidence of chronic and acute inflammation within 5/7 biopsied specimens without evidence of Barrett’s esophagus.

Conclusions

pCLE represents a novel, non-invasive method of tissue diagnosis which may ultimately reduce complications associated with more invasive endoscopic interventions such as tissue biopsy. Additionally, the ability to diagnose at the time of initial endoscopy rather than wait for pathology results may allow for faster and more efficient treatment of this patient population. Although further studies are required, pCLE is a promising new technology in the pre-operative assessment of bariatric patients.

Session: Poster Presentation

Program Number: ETP058