Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy
Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy
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DOI：
10.1111/jgh.13754
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发表时间：
2017-09-01
影响因子：
4.1
通讯作者：
Takahashi-Fujigasaki, Junko
中科院分区：
文献类型：
--
作者：
Kobayashi, Masakuni;Sumiyama, Kazuki;Takahashi-Fujigasaki, Junko
背景和目的：在以往的研究中，我们发现在共聚焦激光内窥镜(CLE)下使用神经荧光探针可以显示肌间神经丛(MP)，但缺乏来自粘膜下侧的临床安全资料。在这项研究中，我们评估了从浆膜侧用甲酚紫(CV)从浆膜侧用基于探针的CLE(PCLE)显示MP的技术可行性。方法：首先利用绿色荧光蛋白标记的神经冠衍生物在体内转基因小鼠模型中探讨CV对MP的染料亲和力。我们还测试了在人体手术标本中进行CV辅助显示MP的可行性，其中组织染色和pCLE观察是从浆膜侧进行的。在人体研究中，以pCLE显示MP的比率作为主要结果进行评估。我们还以MP病理性存在与否为金标准，评价了pCLE显示MP的敏感性和特异性。结果：在所有被测模型中，我们证实了CV对MP的亲和力。在人类研究中，12/14(85.7%)的标本显示MP，其敏感性为92.3%，特异性为100%。在pCLE显示MP呈梯状结构的阳性病例中，神经束的平均最大宽度为54.3(+/-23.6)mm，平均最小宽度为19.7(+/-6.0)mm。10例(83.3%)在pCLE中发现神经节。结论：本研究证实了血管造影辅助pCLE(Umin-CTR编号：UMIN000015056)实时显示MP的技术可行性。
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) mu m, 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).