Real-Time In Vivo Imaging of Early Mucosal Changes during Ischemia-Reperfusion in Human Jejunum 英文参考文献.docVIP

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Real-Time In Vivo Imaging of Early Mucosal Changes during Ischemia-Reperfusion in Human Jejunum 英文参考文献.doc

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Real-Time In Vivo Imaging of Early Mucosal Changes during Ischemia-Reperfusion in Human Jejunum 英文参考文献

Real-TimeInVivoImagingofEarlyMucosalChanges duringIschemia-ReperfusioninHumanJejunum JoepGrootjans1,WimHameeteman2,AdA.Masclee2,RonaldM.vanDam1,WimA.Buurman1, CornelisH.C.Dejong1* 1Department ofSurgery,NUTRIMSchoolfor Nutrition,ToxicologyMetabolism, Maastricht UniversityMedicalCenter,Maastricht,TheNetherlands, 2Department of Gastroenterology,NUTRIMSchoolforNutrition,ToxicologyMetabolism,MaastrichtUniversityMedicalCenter,Maastricht,TheNetherlands Abstract Background and study aims: Small intestinal ischemia-reperfusion (IR) is a frequent, potentially life threatening phenomenon.Thereisalackofnon-invasivediagnosticmodalities.Formanyintestinaldiseases,visualizingtheintestinal mucosausingendoscopyisgoldstandard.However,limitedknowledgeexistsonsmallintestinalIR-induced,earlymucosal changes.TheaimsofthisstudyweretoinvestigateendoscopicchangesinhumanjejunumexposedtoIR,andtostudy concordancebetweenendoscopicappearanceandhistology. Patientsandmethods:In23patientsapartofjejunum,toberemovedforsurgicalreasons,wasisolatedandselectively exposed toischemia with0, 30or120minutesofreperfusion.In3patients,avideocapsulewasinsertedintheisolated segmentbeforeexposuretoIR,tovisualizethemucosa.Endoscopicviewatseveraltimepointswasrelatedtohistology (HeamatoxylinEosin)obtainedfrom20patients. Results:Ischemiawascharacterizedbylossofvillousstructure,mucosalwhiteningandappearanceofpunctatelesions.This wasrelatedtoappearanceofsubepithelialspacesandbreachesintheepitheliallininginthehistologicalview.Earlyduring reperfusion,thelumenfilledwithIR-damaged,shedcellsandVCEshowedmucosalerosions,hemorrhageandintraluminal debris. At 60 minutes of reperfusion, the only remaining signs of IR were loss of villous structure and small erosions, indicatingrapidmucosalhealing. Conclusions:Thisstudyshowsaunique,real-timeinvivoendoscopicviewofearlymucosalchangesduringIRofthehuman smallintestine.FuturestudiesshouldevaluateitsusefulnessindiagnosisofpatientssuspectedofIR. Citation: Grootjans J, Hameeteman W,