Evaluation Of The Function Of Intestinal Mucosa In Patients With Ulcerative Colitis By Confocal Laser Endomicroscopy

Purpose:Ulcerative colitis(UC)is a major involvement of rectum,colon mucosa and submucosa chronic non-specific inflammatory.In recent years,the incidence of UC in China has been rising.Endoscopic evaluation of colonic mucosal healing in ulcerative colitis is increasingly accepted as an important measurement to assess disease activity,treatment goals,prognostic indicator and clinical outcomes.Whether ulcerative colitis has been healed is mainly judged with the use of traditional endoscopy,however,even for patients whose colonic mucosa are judged as "completely healed" under white light endoscopy,there is still a considerable proportion of patients getting relapsed,which means mucosal judged as healed under endoscopy doesn't equal to normal mucosal.Confocal laser endomicroscopy(CLE)has been proved to be reliable for assessment of disease activity of ulcerative colitis.At the same time,it can be used to predict the recurrence of ulcerative colitis by observing the loss of epithelial cells and the absence of mucosal barrier.In this study,the intestinal mucosa of patients with ulcerative colitis were detected by CLE and compared with that of the normal group,in order to explore the advantages of CLE in the evaluation of the function repairing of ulcerative colitis.Methods:30 patients with ulcerative colitis who were diagnosed and treated in the First Affiliated Hospital of Zhejiang University Medical College between 2014.7?2016.12 constitute the study group.The control group was consisted of 10 patients who were diagnosed of colonic polyps with colonoscopy examination and later underwent polypectomy in the First Affiliated Hospital of Zhejiang University Medical College.The UC group received white light endoscopy,gently and slowly into the ileocecus,at the same time the extent of mucosal healing at the whole colon was evaluated.5 ml of 10%fluorescein sodium was intravenous injected into the vein passage after endoscopy reached the base of the ileocecus,and ten minutes later CLE examination was conducted.The left half colon(below the splenic flexure and the colonic segment)showed to be normal under white light but abnormal under CLE were referred for biopsy.The whole CLE examination process was automatically recorded by the system,and the video images were observed and analyzed after being collected,according to the evaluation of sodium fluorescein exudation and barrier function assessment in colon.The control group's process is basically the same as the UC group.Result:The two groups' Boston Score and bowel preparation cleanliness were both up to standard.There was no statistical difference between the 2 groups(p>0.05).The results showed that there were 10 out of 30 cases in the study group whose intestinal mucosa were judged as normal in the whole colon under white light endoscopy.In the other 20 cases,there were parts of intestinal mucosa being judged as abnormal.All of the 10 cases in the control group were with normal colon mucosa.There were significant differences between UC group which showed normal by white light endoscopy and the control group on the fluorescein leakage score by CLE(p<0.05).In the study group,70%cases were judged as normal under white light endoscopy were judged as abnormal under CLE.While in the control group,this statistics was 10%.There was a significant difference between the two groups by CLE(p<0.05).Comparison of the fluorescein leakage score in 20 patients with active ulcerative colitis by CLE in abnormal intestinal segment and normal intestinal mucosa,there was statistical difference between the two groups(p<0.05).A comparison of the fluorescein leakage score and histopathological findings of biopsy in patients by Spearman correlation analysis,those diagnosised normal mucosa of the left colon under endoscopy,Spearman correlation coefficient of the fluorescein leakage score and the HI classification index of histopathological was rs=0.394,p=0.26>0.05,which cannot be considered statistically significant.Conclusion:In patients with ulcerative colitis,mucosal healing for the first structural repair can be proved with the use of CLE,however,mucosal healing under endoscopic cannot represent the functional recovery.In the observation of the subcellular structure,CLE examination was more effective than the histopathological examination in the evaluation of mucosal barrier function.CLE can be used to accurately determine the structure and function of ulcerative colitis,it is expected to be the "gold standard" for the evaluation of mucosal function in patients with ulcerative colitis.