World Congress at ACG2017

Presidential Plenary Session 2 (Free Paper/Abstract Presentations)

6 - In vivo Detection of Colonic Mucosa Microinflammation by Confocal Laser Endomicroscopy Probe (p-CLE) in Patients With Irritable Bowel Syndrome

Monday, October 16
9:30 AM - 9:42 AM
Location: Valencia Ballroom (Level 4)



Award: 2017 Category Award (Functional Bowel Disease)

Category: Functional Bowel Disease       

Carlos Robles-Medranda, MD, Manuel Valero, MD, Miguel Soria-Alcivar, MD, Miguel Puga-Tejada, MD, MSc, Jesenia Ospina-Arboleda, MD, MSc., Haydee Alvarado-Escobar, MD, Guillermo Munoz-Jurado, MD, Roberto Oleas, Hannah Pitanga-Lukashok, MD
Ecuadorian Institute of Digestive Diseases, Guayaquil, Guayas, Ecuador
Introduction: Combination of Rome III criteria have a moderate accuracy for diagnosis of Irritable bowel syndrome (IBS). Colonoscopies are performed to rule out other etiologies, and >50% are normal being considered as a “functional disease”. It has been described and impaired intestinal barrier function with mucosal inflammation in the small bowel of this patients, and recent reports evidence a possible organic disease. However, this fact has not been completely evaluated. Aim: to determine utility of Confocal Laser Endomicroscopy (p-CLE) identifying colorectal mucosa micro-inflammation in patients with IBS.

Methods: Prospective, controlled, non-randomized and simple blind study (Jan-2016/Mar-2017), including patients with IBS according to Roma III criteria (IBS group) and healthy patients (control group). Exclusion criteria: patients receiving NSAIDs, corticosteroids or antibiotics, heart, kidney, liver or severe metabolic disease, IBD, bacterial overgrowth, gastrointestinal bleeding, history of colitis, colonic obstruction, colectomy, allergy to fluorescein, pregnancy and poor bowel preparation (Boston Scale < 6). Both groups underwent colonoscopy using p-CLE with target-biopsy of each colorectal section. Altered crypt architecture, epithelial gaps with fluorescein leaks and dilated and prominent branching vessels were the considered p-CLE criterion for inflammation. Following Geboes Scale, biopsies where evaluated by an only pathologist blinded to endoscopic findings. Overall diagnostic accuracy was defined by sensitivity, specificity, PPV, NPV, observed and inter-rater agreement.

Results: A total of 444 biopsies (74 patients) were included (mean age 53.1 [25-90] yo, 64.9% women). Normal colonoscopy was observed in all cases. There were an increased number of inflammatory lesions at p-CLE in IBS group (65.8%) compared with controls (23.4%) (OR 6.28; 4.14 – 9.52; p < 0.01) (table 1). Goebes' grade >0 was more frequently in IBS group (60.8 vs. 27.5%; p < 0.01). p-CLE for inflammatory findings in IBS, considering target biopsy as gold standard, reached a sensitivity, specificity, PPV, NPV, observed and inter-rater agreement of 86.7, 88.7, 85.9, 89.4, 87.8 and 75.4%.

Discussion: p-CLE proved to be a reliable method for detecting colorectal mucosa micro-inflammation in patients with IBS, showing that patients with IBS have 6 times more prevalence of mucosal colorectal microinflammatory than healthy patients.

Supported by Industry Grant: No


Table 1. Inflammatory lesions at p-CLE, n (%)



















































  IBS-group (n=37) Control group (n=37) p value
Cecum 25 (67.6) 12 (32.4) 0.003
Right colon 28 (75.7) 7 (18.9) <0.001
Transverse colon 23 (62.2) 10 (27.0) 0.002
Left colon 18 (48.6) 6 (16.2) 0.003
Sigmoid 26 (70.3) 8 (21.6) <0.001
Rectum 26 (70.3) 9 (24.3) <0.001
TOTAL 146/222 (65.8)  52/222 (23.4) <0.001




































































 



IBS-group


(n=37)



Control-group


(n=37)



p value



Cecum



25



(67.6)



12



(32.4)



0.003



Right colon



28



(75.7)



7



(18.9)



<0.001



Transverse colon



23



(62.2)



10



(27.0)



0.002



Left colon



18



(48.6)



6



(16.2)



0.003



Sigmoid



26



(70.3)



8



(21.6)



<0.001



Rectum



26



(70.3)



9



(24.3)



<0.001



TOTAL



146/222



(65.8)



52/222



(23.4)



<0.001




Citation: IN VIVO DETECTION OF COLONIC MUCOSA MICROINFLAMMATION BY CONFOCAL LASER ENDOMICROSCOPY PROBE (P-CLE) IN PATIENTS WITH IRRITABLE BOWEL SYNDROME. Program No. 6. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Carlos Robles-Medranda

Head of Division
Ecuadorian Institute of Digestive Disease
Guayaquil, Guayas, Ecuador

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