Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study

Tontini GE, Mudter J, Atreya R, Günther C, Zopf Y, Wildner D, Kiesslich R, Vecchi M, Neurath M, Neumann H, Vieth M (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Endoscopy Thieme Publishing / Georg Thieme Verlag

Book Volume: 47

Pages Range: 437-43

Journal Issue: 5

DOI: 10.1055/s-0034-1391226

Abstract

The differential diagnosis of ulcerative colitis from Crohn's disease is of pivotal importance for the management of inflammatory bowel diseases, as both entities involve specific therapeutic management strategies. Confocal laser endomicroscopy (CLE) allows on-demand, in vivo characterization of architectural and cellular details during endoscopy. The aim of this study was to assess the efficacy of CLE to differentiate between ulcerative colitis and Crohn's disease.This was a prospective study involving consecutive patients with a well-established diagnosis of ulcerative colitis or Crohn's disease who underwent colonoscopy with fluorescein-aided confocal imaging.Overall, 79 patients were included (40 Crohn's disease, 39 ulcerative colitis). CLE findings in patients with Crohn's disease, showed significantly more discontinuous inflammation (87.5 % vs. 5.1 %), focal cryptitis (75.0 % vs. 12.8 %), and discontinuous crypt architectural abnormality (87.5 % vs. 10.3 %) than in ulcerative colitis (P < 0.0001). Conversely, ulcerative colitis was associated with severe, widespread crypt distortion (87.2 % vs. 17.5 % in Crohn's disease), decreased crypt density (79.5 % vs. 22.5 %), and frankly irregular surface (89.7 % vs. 17.5 %; P < 0.0001 for all comparisons). Statistically significant differences were not seen for heavy, diffuse lamina propria cell increase or mucin preservation. No granulomas were visible. Based on these findings, a CLE scoring system was developed that revealed excellent accuracy (93.7 %) when compared with the historical clinical diagnosis and the histopathological gold standard.CLE could visualize several disease-specific microscopic features, which are conventionally used in standard histopathology to differentiate between ulcerative colitis and Crohn's disease. However, because of the limited penetration depth of CLE, submucosal details or granulomas were not visible. The new scoring system may allow in vivo diagnosis of ulcerative colitis or Crohn's disease. Trial registered at ClinicalTrials.gov: NCT 02238665.

Authors with CRIS profile

Raja Atreya Professur für Translationale Immunforschung bei chronisch entzündlichen Darmerkrankungen (Heisenberg-Professur) Claudia Günther Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Yurdagül Zopf Professur für Integrative Medizin mit dem Schwerpunkt Ernährungsmedizin (Stiftungsprofessur der Hector Stiftung II gGmbH) Dane Wildner Medizinische Fakultät Markus Neurath Lehrstuhl für Innere Medizin I Michael Vieth

Involved external institutions

St. Marienkrankenhaus Frankfurt DE Germany (DE) IRCCS Policlinico San Donato IT Italy (IT) Sana Kliniken Ostholstein DE Germany (DE) Klinikum Bayreuth DE Germany (DE)

How to cite

APA:

Tontini, G.E., Mudter, J., Atreya, R., Günther, C., Zopf, Y., Wildner, D.,... Vieth, M. (2015). Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study. Endoscopy, 47(5), 437-43. https://doi.org/10.1055/s-0034-1391226

MLA:

Tontini, Gian Eugenio, et al. "Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study." Endoscopy 47.5 (2015): 437-43.

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