Visualization of the human enteric nervous system by confocal laser endomicroscopy in Hirschsprung's disease: An alternative to intraoperative histopathological diagnosis?
Visualization of the human enteric nervous system by confocal laser endomicroscopy in Hirschsprung's disease: An alternative to intraoperative histopathological diagnosis?
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DOI：
10.1111/nmo.13805
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发表时间：
2020-01-27
影响因子：
3.5
通讯作者：
Sumiyama, Kazuki
中科院分区：
文献类型：
--
作者：
Shimojima, Naoki;Kobayashi, Masakuni;Sumiyama, Kazuki
背景先天性巨结肠症是一种先天性的肠道神经系统异常，由于远端肠道神经节细胞缺乏，出生后不久即表现为严重便秘。先天性巨结肠症的手术需要术中组织病理学诊断，以评估无神经节细胞增多症的程度。共焦激光内窥镜(CLE)是一种新的内窥镜技术，可以在正在进行的内窥镜检查过程中对细胞细节进行实时、活体分析。在这项研究中，我们评估了一种新的CLE应用的可能性，以提供对先天性巨结肠患者的ENS的实时观察。在这项临床前可行性研究中，我们使用手术切除的肠道评估了CLE对ENS的可视化。方法研究对象为2014年9月至2016年3月间接受先天性巨结肠手术的9例患者。结肠标本用0.1%甲酚紫染色，并用激光共聚焦显微镜进行评价。我们将CLE检查结果与组织病理学检查结果进行比较。主要结果神经节节段ENS清晰可见梯状结构，无神经节段未见ENS。在69例标本中，有61例(88%)获得了CLE和组织病理学的相应阳性和阴性结果。此外，CLE能够观察到独特的波状结构，其中包括具有先天性巨结肠症无神经节/过渡区特征的粗大神经束。结论和推论作为一种可视化人类神经的新工具，CLE有可能革命性地改变儿科外科医生在先天性巨结肠手术中识别神经节病水平的方式，并可能成为术中组织病理学诊断的一种更好的替代方案。
Background Hirschsprung's disease is a congenital abnormality of the enteric nervous system (ENS) presenting severe constipation soon after birth due to the lack of ganglion cells in the distal gut. Surgery for Hirschsprung's disease requires an intraoperative histopathological diagnosis to assess the extent of aganglionosis. Confocal laser endomicroscopy (CLE) is a novel endoscopic technique allowing real-time, in vivo analysis of cellular details during ongoing endoscopy. In this study, we evaluated the possibility of a new application of CLE to provide real-time observations of the ENS in patients with Hirschsprung's disease. In this preclinical feasibility study, we assessed the visualization of the ENS by CLE using surgically resected intestines. Methods The subjects were nine patients who underwent pull-through surgery for Hirschsprung's disease between September 2014 and March 2016. The colon specimens were stained with 0.1% cresyl violet and evaluated using CLE. We compared the CLE findings with those of the histopathological examination. Key Results The ENS was clearly visualized as a ladder-like structure in the ganglionic segment but was not observed in the aganglionic segment. Of the 69 samples, corresponding positive and negative results for both CLE and the histopathology were obtained in 61 (88%). In addition, CLE was able to visualize unique, wavy structures comprising thick nerve bundles characteristic of the aganglionic/transition zone in Hirschsprung's disease. Conclusions and Inferences As a novel tool for visualizing the human ENS, CLE has the potential to revolutionize how pediatric surgeons identify the level of ganglionosis during surgery for Hirschsprung's disease and may be a superior alternative to intraoperative histopathological diagnosis.