Endoscopy 2019; 51(04): S81
DOI: 10.1055/s-0039-1681407
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: IBD Club A
Georg Thieme Verlag KG Stuttgart · New York

CONFOCAL LASER ENDOMICROSCOPY CAN PREDICT MAJOR CLINICAL EVENTS WITH VERY HIGH SENSITIVITY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

E Klenske
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
R Atreya
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
S Zundler
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
S Fischer
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
M Neurath
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
T Rath
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Probe-based confocal laser endomicroscopy (pCLE) enables in vivo microscopic imaging during ongoing endoscopy. Further, pCLE enables visualization of mucosal barrier dysfunction (MBD) in patients with inflammatory bowel diseases (IBD). With this, pCLE is the only technology allowing functional imaging within the GI tract in IBD patients. Here we evaluated whether assessment of MBD by pCLE can accurately predict major clinical events (MCE) in IBD patients.

Methods:

IBD patients in clinical and endoscopic remission were prospectively enrolled. pCLE was performed initially and subsequently patients were followed-up for at least 12 months. During follow-up, major clinical events (MCE: IBD-related hospitalization, need for surgery, need for initiation of systemic corticosteroids, immunosuppressants or biologics; escalation of existing biologic therapy) were recorded.

Results:

60 patients were prospectively included (37 Crohn's disease [CD], 23 ulcerative colitis [UC]) with a median age of 38 years (range 19 – 68). CLE-scoring showed strong correlation with histopathology (r≥0.75, p ≤0.05) with an almost perfect interobserver agreement of pCLE findings among different readers (Kappa > 0.8). MBD as assessed with pCLE in the terminal ileum showed 100% sensitivity (95% CI, 77 – 100), 75% specificity (95% CI, 47 – 92) and 88% accuracy in CD patients and 83.3% sensitivity (95% CI, 50.8 – 97.1), 81.8% specificity (95% CI, 47.8 – 96.8) and 82.6% accuracy in UC patients for predicting MCEs during the 12 month follow-up. In those patients with MBD in the colon, sensitivity, specificity and accuracy for predicting MCEs with pCLE were 91.7% (95% CI, 59.8 – 99.6), 72.8% (95% CI, 39.3 – 92.7) and 82.6%, respectively.

Conclusions:

By assessing MBD in vivo, pCLE allows to predict MCE in IBD patients in clinical and endoscopic remission with very high sensitivity. Therefore, pCLE can be used to effectively time and personalize anti-inflammatory treatment in IBD patients.