Sa1603 Accuracy of Endoscopic Based Confocal Laser Endomicroscopy of Donor Duodenum in Early Detection of Pancreas Rejection in a Recipient of Simultaneous Duodenum-Drained Pancreas - Kidney Transplantation

Abstract

Sa1603 Accuracy of Endoscopic Based Confocal Laser Endomicroscopy of Donor Duodenum in Early Detection of Pancreas Rejection in a Recipient of Simultaneous Duodenum-Drained Pancreas Kidney Transplantation Marek Stobinski*, Janusz Milewski, Aleksandra Poplawska, Marek Durlik, Agnieszka Serwacka, Andrzej Rydzewski, Grazyna Rydzewska Dpt. of Internal Medicine and Gastroenterology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warszawa, Poland; Dpt. of Gastroenterological and Transplantation Surgery, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warszawa, Poland; Dpt. of Internal Medicine and Nefrology, Central Clinical Hospital of Ministry of Internal Affairs and Administration, Warszawa, Poland Background and aims: Confocal laser endomicroscopy (CLE) is a new, powerful technic, allows to get in vivo histology. This technology is widely investigated in different gastrointestinal diseases and becomes an alternative to conventional histology. Percutaneous transplanted pancreas biopsy under imaging control is the method of choice in monitoring of organ rejection, however adequate samples are obtained in 73-89% of biopsy attempts. Recently we described also usefulness of transplanted duodenum biopsies for graft rejection monitoring. However histology technique is time consuming, so the aim of the present study was to investigate usefulness of CLE in monitoring of acute pancreas rejection, and it’s influence on potential clinical decision. Patients and methods: During first 2 weeks after SPK procedure 18 patients were examined with CLE technique and histological biopsies from transplanted and own duodenum were also taken for confirmation of endoscopic changes. No difficulties to reach anastomosis with CLE were observed. Results: In the group of 18 patients after SPK transplantation we found in 2 cases endoscopic changes in transplanted duodenum, expressed as destruction of the villi and dispersed globlet cells in comparison to their own healthy duodenum. No macroscopic changes in transplanted duodenum in those patients were observed. In both cases histological examination confirmed acute organ rejection. Patients were operated and graft was removed. Conclusion: In our pilot study we demonstrated for the first time, that CLE is a promising and effective method to detect acute phase GvHD and also for follow up in those patients group. The procedure is easy acceptable and safe for patients and clinical decision based on the information obtained after examination could be made quickly. Further studies are needed to confirmed clinical usefulness of this technique in monitoring of patients after SPK transplantation. Sa1604 Mucosal Healing in Patients With Ulcerative Colitis Assessed by Confocal Laser Endomicroscopy Cristian Gheorghe, Razvan Iacob*, Bogdan Cotruta, Ion Bancila, Gabriel Becheanu, Mona Dumbrava, Liana Gheorghe Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania; Gastroenterology and Hepatology, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania Background & Aim: The ultimate therapeutic goal in patients with ulcerative colitis (UC) is represented by mucosal healing. Recently, confocal LASER endomicroscopy (CLE) has emerged to allow in vivo histological evaluation during ongoing endoscopy. Considering that histologic remission should be part of sustained deep remission, we have conducted a pilot study to investigate the ability of CLE to differentiate between normal mucosa and residual inflammation. Methods: Rectal CLE has been performed using 5 ml 10% fluorescein iv and targeted biopsies have been analysed by the pathologist. Mucosal inflammation was investigated by CLE assessing crypt architecture and interstitial and cryptal fluorescein leakage. The image processing was performed using ImageJ, a public domain Java software. All images have been captured using the same LASER power setting, at the superficial and medium-depth level. Semiautomatic computer estimation of interstitial and cryptal fluorescein leakage (ICFL) has been performed on stacks of images, by evaluating mean luminosity of pixels corresponding to crypts and interstitium, on a scale ranging from 0-255. ICFL in patients with UC in histological remission has been compared to patients with active ulcerative colitis and to patients with irritable bowel syndrome undergoing screening colonoscopy for colorectal cancer, using Student’s T Test. Results: A total of 184 CLE images have been analysed. Only minor cryptal abnormalities have been noted for patients with ulcerative colitis in remission, whereas for patients with active ulcerative colitis a wide range of cryptal alterations have been registered, from crypt distortion to crypt destruction and crypt abcess. ICFL was 94 21 for patients with ulcerative colitis in histological remission, 106 12.6 for IBS controls (p 0.24 -NS) and 178.6 21.6 for patients with active UC (p 0.0001). Conclusion: CLE is an emerging endoscopic technique for real-time assessment of deep mucosal remission during ongoing endoscopic examination, in patients with UC. The semiautomatic quantification of interstitial and cryptal fluorescein leakage can be objectively used to diagnose in vivo deep mucosal remission in patients with UC. Abstracts