Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy

Masakuni Kobayashi, Kazuki Sumiyama, Naoki Shimojima, Satoshi Ieiri, Hideyuki Okano, Shunsuke Kamba, Takumi Fujimura, Seiichi Hirobe, Tatsuo Kuroda, Junko Takahashi-Fujigasaki

Research output: Contribution to journalArticle

Abstract

Background and Aim: In preceding studies, we identified that the myenteric plexus (MP) could be visualized with confocal laser endomicroscopy (CLE) by applying neural fluorescent probes lacking clinical safety profiling data from the submucosal side. In this study, we evaluated the technical feasibility of MP visualization using probe-based CLE (pCLE) from the serosal side with cresyl violet (CV), which has been used clinically for chromoendoscopy. Methods: The dye affinity of CV for MP was first explored in an in vivo transgenic mouse model using neural crest derivatives labeled with green fluorescent protein. We also tested the feasibility of CV-assisted visualization of MP in human surgical specimens, wherein the tissue dying and pCLE observation were performed from the serosal side. In the human study, rate of MP visualization by pCLE was evaluated as the primary outcome. We also evaluated the sensitivity and specificity of MP visualization by pCLE, using pathological presence/absence of MP as the gold standard. Results: We confirmed the dye affinity of CV to MP in all tested models. The MP appeared as brightly stained ladder-like structures with pCLE, and in the human study, MP was visualized in 12/14 (85.7%) samples, with 92.3% sensitivity and 100% specificity. In positive cases showing the ladder-like structure of MP by pCLE, the mean maximum and minimum widths of nerve strands were 54.3 (± 23.6) and 19.7 (± 6.0) μm, respectively. A ganglion was detected by pCLE in 10 cases (10/12, 83.3%). Conclusions: This study demonstrated the technical feasibility of visualizing the MP in real time by CV-assisted pCLE (UMIN-CTR number, UMIN000015056).

Original languageEnglish
Pages (from-to)1604-1610
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number9
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Myenteric Plexus
Lasers
Coloring Agents
Sensitivity and Specificity
Neural Crest
Green Fluorescent Proteins
Fluorescent Dyes
Ganglia
Transgenic Mice

Keywords

  • clinical pediatric gastroenterology
  • endoscopy: colon
  • pediatric disorders

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Kobayashi, M., Sumiyama, K., Shimojima, N., Ieiri, S., Okano, H., Kamba, S., ... Takahashi-Fujigasaki, J. (2017). Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy. Journal of Gastroenterology and Hepatology (Australia), 32(9), 1604-1610. https://doi.org/10.1111/jgh.13754

Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy. / Kobayashi, Masakuni; Sumiyama, Kazuki; Shimojima, Naoki; Ieiri, Satoshi; Okano, Hideyuki; Kamba, Shunsuke; Fujimura, Takumi; Hirobe, Seiichi; Kuroda, Tatsuo; Takahashi-Fujigasaki, Junko.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 32, No. 9, 01.09.2017, p. 1604-1610.

Research output: Contribution to journalArticle

Kobayashi, M, Sumiyama, K, Shimojima, N, Ieiri, S, Okano, H, Kamba, S, Fujimura, T, Hirobe, S, Kuroda, T & Takahashi-Fujigasaki, J 2017, 'Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy', Journal of Gastroenterology and Hepatology (Australia), vol. 32, no. 9, pp. 1604-1610. https://doi.org/10.1111/jgh.13754
Kobayashi, Masakuni ; Sumiyama, Kazuki ; Shimojima, Naoki ; Ieiri, Satoshi ; Okano, Hideyuki ; Kamba, Shunsuke ; Fujimura, Takumi ; Hirobe, Seiichi ; Kuroda, Tatsuo ; Takahashi-Fujigasaki, Junko. / Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy. In: Journal of Gastroenterology and Hepatology (Australia). 2017 ; Vol. 32, No. 9. pp. 1604-1610.
@article{9c51871e6b254c6a82864c7bee971a46,
title = "Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy",
abstract = "Background and Aim: In preceding studies, we identified that the myenteric plexus (MP) could be visualized with confocal laser endomicroscopy (CLE) by applying neural fluorescent probes lacking clinical safety profiling data from the submucosal side. In this study, we evaluated the technical feasibility of MP visualization using probe-based CLE (pCLE) from the serosal side with cresyl violet (CV), which has been used clinically for chromoendoscopy. Methods: The dye affinity of CV for MP was first explored in an in vivo transgenic mouse model using neural crest derivatives labeled with green fluorescent protein. We also tested the feasibility of CV-assisted visualization of MP in human surgical specimens, wherein the tissue dying and pCLE observation were performed from the serosal side. In the human study, rate of MP visualization by pCLE was evaluated as the primary outcome. We also evaluated the sensitivity and specificity of MP visualization by pCLE, using pathological presence/absence of MP as the gold standard. Results: We confirmed the dye affinity of CV to MP in all tested models. The MP appeared as brightly stained ladder-like structures with pCLE, and in the human study, MP was visualized in 12/14 (85.7{\%}) samples, with 92.3{\%} sensitivity and 100{\%} specificity. In positive cases showing the ladder-like structure of MP by pCLE, the mean maximum and minimum widths of nerve strands were 54.3 (± 23.6) and 19.7 (± 6.0) μm, respectively. A ganglion was detected by pCLE in 10 cases (10/12, 83.3{\%}). Conclusions: This study demonstrated the technical feasibility of visualizing the MP in real time by CV-assisted pCLE (UMIN-CTR number, UMIN000015056).",
keywords = "clinical pediatric gastroenterology, endoscopy: colon, pediatric disorders",
author = "Masakuni Kobayashi and Kazuki Sumiyama and Naoki Shimojima and Satoshi Ieiri and Hideyuki Okano and Shunsuke Kamba and Takumi Fujimura and Seiichi Hirobe and Tatsuo Kuroda and Junko Takahashi-Fujigasaki",
year = "2017",
month = "9",
day = "1",
doi = "10.1111/jgh.13754",
language = "English",
volume = "32",
pages = "1604--1610",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Technical feasibility of visualizing myenteric plexus using confocal laser endomicroscopy

AU - Kobayashi, Masakuni

AU - Sumiyama, Kazuki

AU - Shimojima, Naoki

AU - Ieiri, Satoshi

AU - Okano, Hideyuki

AU - Kamba, Shunsuke

AU - Fujimura, Takumi

AU - Hirobe, Seiichi

AU - Kuroda, Tatsuo

AU - Takahashi-Fujigasaki, Junko

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background and Aim: In preceding studies, we identified that the myenteric plexus (MP) could be visualized with confocal laser endomicroscopy (CLE) by applying neural fluorescent probes lacking clinical safety profiling data from the submucosal side. In this study, we evaluated the technical feasibility of MP visualization using probe-based CLE (pCLE) from the serosal side with cresyl violet (CV), which has been used clinically for chromoendoscopy. Methods: The dye affinity of CV for MP was first explored in an in vivo transgenic mouse model using neural crest derivatives labeled with green fluorescent protein. We also tested the feasibility of CV-assisted visualization of MP in human surgical specimens, wherein the tissue dying and pCLE observation were performed from the serosal side. In the human study, rate of MP visualization by pCLE was evaluated as the primary outcome. We also evaluated the sensitivity and specificity of MP visualization by pCLE, using pathological presence/absence of MP as the gold standard. Results: We confirmed the dye affinity of CV to MP in all tested models. The MP appeared as brightly stained ladder-like structures with pCLE, and in the human study, MP was visualized in 12/14 (85.7%) samples, with 92.3% sensitivity and 100% specificity. In positive cases showing the ladder-like structure of MP by pCLE, the mean maximum and minimum widths of nerve strands were 54.3 (± 23.6) and 19.7 (± 6.0) μm, respectively. A ganglion was detected by pCLE in 10 cases (10/12, 83.3%). Conclusions: This study demonstrated the technical feasibility of visualizing the MP in real time by CV-assisted pCLE (UMIN-CTR number, UMIN000015056).

AB - Background and Aim: In preceding studies, we identified that the myenteric plexus (MP) could be visualized with confocal laser endomicroscopy (CLE) by applying neural fluorescent probes lacking clinical safety profiling data from the submucosal side. In this study, we evaluated the technical feasibility of MP visualization using probe-based CLE (pCLE) from the serosal side with cresyl violet (CV), which has been used clinically for chromoendoscopy. Methods: The dye affinity of CV for MP was first explored in an in vivo transgenic mouse model using neural crest derivatives labeled with green fluorescent protein. We also tested the feasibility of CV-assisted visualization of MP in human surgical specimens, wherein the tissue dying and pCLE observation were performed from the serosal side. In the human study, rate of MP visualization by pCLE was evaluated as the primary outcome. We also evaluated the sensitivity and specificity of MP visualization by pCLE, using pathological presence/absence of MP as the gold standard. Results: We confirmed the dye affinity of CV to MP in all tested models. The MP appeared as brightly stained ladder-like structures with pCLE, and in the human study, MP was visualized in 12/14 (85.7%) samples, with 92.3% sensitivity and 100% specificity. In positive cases showing the ladder-like structure of MP by pCLE, the mean maximum and minimum widths of nerve strands were 54.3 (± 23.6) and 19.7 (± 6.0) μm, respectively. A ganglion was detected by pCLE in 10 cases (10/12, 83.3%). Conclusions: This study demonstrated the technical feasibility of visualizing the MP in real time by CV-assisted pCLE (UMIN-CTR number, UMIN000015056).

KW - clinical pediatric gastroenterology

KW - endoscopy: colon

KW - pediatric disorders

UR - http://www.scopus.com/inward/record.url?scp=85028357166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028357166&partnerID=8YFLogxK

U2 - 10.1111/jgh.13754

DO - 10.1111/jgh.13754

M3 - Article

C2 - 28142194

AN - SCOPUS:85028357166

VL - 32

SP - 1604

EP - 1610

JO - Journal of Gastroenterology and Hepatology (Australia)

JF - Journal of Gastroenterology and Hepatology (Australia)

SN - 0815-9319

IS - 9

ER -