Confocal Laser Endomicroscopic Findings of Refractory Erosive Reflux Disease versus Non-Erosive Reflux Disease with Anti-Reflux Mucosectomy: An in vivo and ex vivo Study
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Background/Aims: To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is anon-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has beenshown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo andex vivo through CLE in patients with GERD. Methods: Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed invivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular andvascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group. Results: Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patientswith ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter,number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in theNERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD. Conclusions: The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnoseNERD with high sensitivity and accuracy.
Abstract
Background/Aims: To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is anon-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has beenshown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo andex vivo through CLE in patients with GERD. Methods: Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed invivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular andvascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group. Results: Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patientswith ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter,number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in theNERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD. Conclusions: The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnoseNERD with high sensitivity and accuracy.
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