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Observational study;Confocal endomicroscopy in the diagnosis of colorectal neoplasia.

ABSTRACT: Interventions: Both techniques (conventional colonoscopy and confocal endomicroscopy) are routinely used in clinical practice at the Department of Gastroenterology of our hospital. In this regard, patients participating in the study will not undergo additional (invasive) examination. As the duration of the chromoscopy-guided confocal endomicroscopy procedure is somewhat longer than the standard procedure, the patient-burden will possibly increase, mainly due to the ‘back-to-back’ evaluation. The potential advantage is the achievement of higher diagnostic accuracy of preneoplastic lesions in this high-risk population. During confocal endomicroscopy fluorescein will be administred intravenously, to generate confocal images. This is a safe contrast-agent which has been previously used for the diagnosis of ophtalmologic diseases (e.g. corneal infections). Additionally, fluorescein has been already used in more than 1000 patients undergoing confocal endomicroscopy, without relevant adverse events. Allergic reactions, in particular nausea seldom occur. Also, transient yellow discoloration of urine and skin may occur. The general risks associated to the colonoscopic procedure are detailed in the endoscopy-folder of the GI Endoscopy Unit of the University Hospital Maastricht. Primary outcome(s): The primary outcome measure will be the number of patients with at least one adenoma after conventional colonoscopy compared with the number of patients with at least one adenoma after pan-chromoendoscopy. Study Design: N/A: single arm study, Open (masking not used), N/A , unknown, Crossover

DISEASE(S): Adenomatous Polyps (adenomateuze Poliepen),Colorectal Cancer (coloncarcinoom),Chromoendoscopy (chromoendoscopie),Confocal Endomicroscopy (confocale Endomicroscopie).

PROVIDER: 15491 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Confocal endomicroscopy is an emerging technique that allows in vivo imaging of cells and tissue structures of the gastrointestinal mucosa, with a magnification of about 1000 times, guiding optical biopsies in real time. Confocal endomicroscopy represents technique that combines conventional white light image with the confocal microscope probe, thereby allowing examination of the surface epithelium in vivo and histological diagnosis during endoscopy. Among the applications already established for its use, stand out diagnosis of Barrett’s esophagus, gastric atrophy and intestinal metaplasia, celiac disease, differentiation of hyperplastic adenomatous polyps of the colon, microscopic colitis and follow-up of patients with inflammatory disease, reducing the need for endoscopic biopsies. The CLE can still detect molecular changes effectively improving the endoscopic diagnosis. This pilot project consists of 07 subprojects which the technology of confocal endomicroscopia will be evaluated and compared with the histological results of biopsy or surgical specimens: 1. confocal endomicroscopy for the diagnosis of high-grade dysplasia and superficial esophageal adenocarcinoma in patients with Barrett’s esophagus 2 Diagnosis of superficial esophageal squamous cell carcinoma in patients with head and neck cancer by confocal endomicroscopy 3 Detect the presence of premalignant lesions in the gastric stump in patients with reflux alkaline gastritis after partial gastrectomy 4. detect lesions in the gastric mucosa of patients with familial history of gastric cancer 5 Biliary Strictures: differential diagnosis by confocal endomicroscopia 6 confocal Endomicroscopy of cystic neoplasms of the pancreas 7 Contribution of confocal endomicroscopy for the differential diagnosis of colorectal polyps The project aims to deploy the structure of the Confocal endomicroscopy Endoscopy ICESP, for performing in vivo histological examinations of the digestive tract, biliary tract and pancreas. All research groups involved in the early detection of tumors of the esophagus, stomach, biliary tract, pancreas, colon and rectum may benefit from the implementation of this methodology.

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Observational study;Confocal endomicroscopy in the diagnosis of colorectal neoplasia.

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