A new method in the diagnosis of reflux esophagitis: confocal laser endomicroscopy

Abstract

Background: The diagnosis of GERD is made by using a combination of clinical symptoms, pH study, endoscopy, and histology. Histologic changes include basal cell hyperplasia and papillary elongation. Confocal laser endomicroscopy (CLE) enables surface and subsurface imaging of living cells in vivo at ×1000 magnification and up to 250 μm below the tissue surface. In the esophagus, the distance between the surface to papillary (S-P) tip can be measured by using CLE.

Objective: To measure the S-P distance in the esophagus in patients with reflux esophagitis and controls by using CLE and comparing with histologic measurements.

Design: Retrospective analysis of a prospective database.

Setting: Endoscopy unit of a tertiary-care children's hospital.

Patients: This study involved 7 patients (5 female) with a median age of 7.6 years (range 1.8-15.5 years) and median weight of 23 kg (range 13.2-71 kg) and 16 controls with a median age of 12.0 years (range 2.2-15.3 years) and median weight of 38.2 kg (range 10.7-83 kg).

Intervention: S-P distance was measured both by CLE and histology and was corrected for height for both patients and controls and the results compared.

Main outcome measurements: To determine if there were significant differences in the S-P distance in patients with esophagitis and controls.

Results: The median confocal and histologic measurements for S-P distance, corrected for patient height, were 0.19 μm/cm (range 0.10-0.49 μm/cm) and 0.58 μm/cm (range 0.29-0.76 μm/cm) and for controls were 0.44 μm/cm (range 0.20-0.93 μm/cm) and 1.07 μm/cm (range 0.76-0.1.57 μm/cm), respectively.

Limitations: Small numbers involved in the study, reliance on only papillary elongation in arriving at a diagnosis.

Conclusion: Measurement of the S-P distance by CLE will enable real-time diagnosis of GERD-related esophagitis during ongoing endoscopy.