An investigation of the diagnostic, predictive, and prognostic impacts of three colonic biopsy grading systems for acute graft versus host disease.

Acute graft versus host disease (aGvHD) is an important, life-threatening complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). To investigate the value of multiple simultaneous colon biopsies in improving diagnostic accuracy in patients with aGvHD, we retrospectively analyzed 157 patients after alloHSCT. The biopsies were evaluated individually using three established histological grading systems (Lerner, Sale, and Melson). The maximum, minimum, median, and mean histological aGvHD grades were calculated for each patient, and the results were correlated with the Glucksberg grade of clinical manifestation of GvHD, steroid therapy status, and outcome. We found that…

Motion Artifact Detection in Confocal Laser Endomicroscopy Images

Confocal Laser Endomicroscopy (CLE), an optical imaging technique allowing non-invasive examination of the mucosa on a (sub)- cellular level, has proven to be a valuable diagnostic tool in gastroenterology and shows promising results in various anatomical regions including the oral cavity. Recently, the feasibility of automatic carcinoma detection for CLE images of sufficient quality was shown. However, in real world data sets a high amount of CLE images is corrupted by artifacts. Amongst the most prevalent artifact types are motion-induced image deteriorations. In the scope of this work, algorithmic approaches for the automatic detection of motion artifact-tainted image regions were develo…

Review article: in vivo imaging by endocytoscopy

Aliment Pharmacol Ther 2011; 33: 1183–1193 Summary Background  Endocytoscopy (EC) enables in vivo microscopic imaging at 1400-fold magnification, thereby allowing the analysis of mucosal structures at the cellular level. In contrast to fluorescence imaging with confocal laser endomicroscopy which allows analysis of mucosal structures up to 250 μm in depth, EC is based on the principle of contact light microscopy and only allows visualisation of the very superficial mucosal layer. Aim  To systematically review the feasibility and diagnostic yield of EC for in vivo diagnosis of diseases. Methods  A systematic search of the literature on diagnostic interventions in the gastrointestinal tract u…

Panintestinal capsule endoscopy in patients with celiac disease

INTRODUCTION Capsule endoscopy has proven its utility in diagnosing villous atrophy and lymphoma in patients with celiac disease. Recently, a novel capsule endoscopy system was introduced which enables the examination of the small and large bowel. So far, it has not been evaluated in patients with celiac disease. OBJECTIVE The primary objective of this study was to evaluate the novel panintestinal capsule endoscopy system in patients with celiac disease. METHODS Eleven patients with histologically proven celiac disease (Marsh 0-IV), who underwent a panintestinal capsule endoscopy between March 2018 and April 2019 at our institution, were included in this retrospective single-center study. A…

Antibodies against tumor necrosis factor (TNF) induce T-cell apoptosis in patients with inflammatory bowel diseases via TNF receptor 2 and intestinal CD14⁺ macrophages.

Background & Aims The anti–tumor necrosis factor (TNF) antibodies infliximab, adalimumab, and certolizumab pegol have proven clinical efficacy in Crohn's disease. Here, we assessed the effects of anti-TNF antibodies on apoptosis in inflammatory bowel disease (IBD). Methods CD14 + macrophages and CD4 + T cells were isolated from peripheral blood and lamina propria mononuclear cells from patients with IBD and control patients. Cell surface markers and apoptosis were assessed by immunohistology and fluorescence-activated cell sorting techniques. Results Lamina propria CD14 + macrophages showed significantly more frequent and higher membrane-bound TNF (mTNF) expression than CD4 + T cells in IBD…

Development and validation of the SIMPLE endoscopic classification of diminutive and small colorectal polyps

Abstract Background Prediction of histology of small polyps facilitates colonoscopic treatment. The aims of this study were: 1) to develop a simplified polyp classification, 2) to evaluate its performance in predicting polyp histology, and 3) to evaluate the reproducibility of the classification by trainees using multiplatform endoscopic systems. Methods In phase 1, a new simplified endoscopic classification for polyps – Simplified Identification Method for Polyp Labeling during Endoscopy (SIMPLE) – was created, using the new I-SCAN OE system (Pentax, Tokyo, Japan), by eight international experts. In phase 2, the accuracy, level of confidence, and interobserver agreement to predict polyp hi…

Diagnose von Intraduktal papillär-muzinöse Neoplasien (IPMN) – Bestandsaufnahme der Versorgungsrealität an einem deutschen Zentrum

Mehrwert von EUS gesteuerten Fein-Nadel-Biopsien (FNB) gegenüber FN-Aspiration (FNA) von unklaren Läsionen im Gastrointestinal (GI)-Trakt

Confocal Laser Endomicroscopy: Technical Advances and Clinical Applications

Since its introduction in 2004, confocal laser endomicroscopy (CLE) has emerged as a valuable tool for gastrointestinal endoscopic imaging. Endomicroscopy enables the endoscopist to obtain real time in vivo histology during ongoing endoscopy thereby creating “optical biopsies.” To date, numerous studies have shown potential applications of endomicroscopy in the clinical setting, including in vivo diagnosis of esophageal squamous cell carcinoma, Barrett’s esophagus, celiac disease, and colonic polyps. Moreover, recent data suggest the potential application of endomicroscopy in the field of molecular imaging. Additionally, in recent months new applications and developments in the field of con…

Diagnosis and grading of acute graft-versus-host disease in endoscopic biopsy series throughout the upper and lower intestine in patients after allogenic hematopoietic stem cell transplantation: a systematic approach.

Intestinal graft-versus-host disease (GvHD) is a potentially life-threatening condition after allogenic hematological stem cell transplantation (alloHSCT). Although efforts have been made to determine the best sites for endoscopic biopsies, an approach involving all accessible anatomical regions is lacking. We investigated 22 complete biopsy series, each comprising biopsies from 10 different sites of the upper and lower intestine from 21 patients. The majority of biopsies investigated revealed histological signs of acute GvHD. The highest incidence and most advanced grades of acute GvHD were found in the right colon and terminal ileum. We detected significant correlations between crypt or g…

Diagnostische Wertigkeit der Endoskopie zur Erkennung einer GvHD im oberen Gastrointestinaltrakt

Caspase-8 regulates TNF-alpha induced epithelial necroptosis and terminal ileitis

Two groups identify the regulation of death-receptor-induced necroptosis as an epithelial intrinsic mechanism that is important for the maintenance of immune homeostasis and the prevention of intestinal inflammation in mice. Welz et al. describe an unexpected physiological function for FADD (Fas-associated protein with death domain), an adaptor protein required for death-receptor-induced apoptosis. Mice with intestinal epithelial specific knockout of FADD develop severe colon inflammation due to increased death of FADD-deficient colonic epithelial cells. Gunther et al. report a novel and unexpected function of caspase-8 in maintaining immune homeostasis in the gut. Caspase-8 expression by g…