Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

다국어 초록 (Multilingual Abstract)

Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein.
This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE.
Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in thestudy. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination ofthe optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by threeendoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were notdeemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated.
Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLEwith IV fluorescein at 0.5 mg/kg.
Conclusions: In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both theupper and lower GI tract.

참고문헌 (Reference)

1 Keerl R, "Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas : an analysis of 420 administrations and reported complications in Europe and the United States" 114 : 266-272, 2004

2 Wallace MB, "The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract" 31 : 548-552, 2010

3 Buchner AM, "The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia" 73 : 556-560, 2011

4 Pittayanon R, "The learning curve of gastric intestinal metaplasia interpretation on the images obtained by probe-based confocal laser endomicroscopy" 2012 : 278045-, 2012

5 Tashima T, "Successful ex-vivo probe-based confocal laser endomicroscopy of a superficial nonampullary duodenal epithelial tumor with dripping of food additives : a case of tubular adenocarcinoma" 4 : 128-130, 2019

6 Sharma P, "Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy : final results of an international multicenter, prospective, randomized, controlled trial" 74 : 465-472, 2011

7 Nonaka K, "Probe-based confocal laser endomicroscopy of the duodenal mucosa with fluorescein dispersion" 26 : 604-, 2014

8 Park JC, "Probe-based confocal laser endomicroscopy in the margin delineation of early gastric cancer for endoscopic submucosal dissection" 32 : 1046-1054, 2017

9 Spessotto P, "Probe-based confocal laser endomicroscopy for in vivo evaluation of the tumor vasculature in gastric and rectal carcinomas" 7 : 9819-, 2017

10 Kim B, "Probe-based confocal laser endomicroscopy for evaluating the submucosal invasion of colorectal neoplasms" 31 : 594-601, 2017

11 Wallace MB, "Probe-based confocal laser endomicroscopy" 136 : 1509-1513, 2009

12 Abe S, "Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms : an initial experience in Japan" 33 : 1071-1078, 2018

13 Tian Y, "Papaverine adjuvant therapy for microcirculatory disturbance in severe ulcerative colitis complicated with CMV infection : a case report" 12 : 407-413, 2019

14 Löhr JM, "Outcome of probe-based confocal laser endomicroscopy(pCLE)during endoscopic retrograde cholangiopancreatography : a single-center prospective study in 45 patients" 3 : 551-560, 2015

15 Dowlati A, "Novel phase I dose de-escalation design trial to determine the biological modulatory dose of the antiangiogenic agent SU5416" 11 : 7938-7944, 2005

16 Sano Y, "Narrow-band imaging(NBI)magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI expert team" 28 : 526-533, 2016

17 Wallace M, "Miami classification for probebased confocal laser endomicroscopy" 43 : 882-891, 2011

18 Xu K, "Intravenous fluorescein angiography-associated adverse reactions" 51 : 321-325, 2016

19 Nonaka K, "Histopathological confirmation of similar intramucosal distribution of fluorescein in both intravenous administration and local mucosal application for probe-based confocal laser endomicroscopy of the normal stomach" 3 : 993-999, 2015

20 Yannuzzi LA, "Fluorescein angiography complication survey" 93 : 611-617, 1986

21 Shahid MW, "Exploring the optimal fluorescein dose in probe-based confocal laser endomicroscopy for colonic imaging" 1 : 166-171, 2011

22 Caillol F, "Evaluation of pCLE in the bile duct : final results of EMID study : pCLE : impact in the management of bile duct strictures" 29 : 2661-2668, 2015

23 McLauchlan R, "Ethnic variation in fluorescein angiography induced nausea and vomiting" 15 (15): 159-162, 2001

24 Caillol F, "Endomicroscopy in bile duct : inflammation interferes with pCLE applied in the bile duct : a prospective study of 54 patients" 1 : 120-127, 2013

25 Wu K, "Dynamic real-time microscopy of the urinary tract using confocal laser endomicroscopy" 78 : 225-231, 2011

26 Wellikoff AS, "Comparison of in vivo probe-based confocal laser endomicroscopy with histopathology in lung cancer : a move toward optical biopsy" 20 : 967-974, 2015

27 Meining A, "Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures" 44 : 251-257, 2012

28 Ha SO, "Anaphylaxis caused by intravenous fluorescein : clinical characteristics and review of literature" 9 : 325-330, 2014

29 Lira RP, "Adverse reactions of fluorescein angiography : a prospective study" 70 : 615-618, 2007

30 Marcus DF, "Adverse reactions during intravenous fluorescein angiography" 102 : 825-, 1984

31 Shah T, "Accuracy of probe-based confocal laser endomicroscopy(pCLE)compared to random biopsies during endoscopic surveillance of Barrett’s esophagus" 6 : E414-E420, 2018

32 Zhang YL, "A lower dose of fluorescein sodium is more suitable for confocal laser endomicroscopy : a feasibility study" 84 : 917-923, 2016