A lower dose of fluorescein sodium is more suitable for confocal laser endomicroscopy: a feasibility study.

Ya-Lin Zhang, Liang Bai, Zhen Li, Rui Ji, Chang-Qing Li, Xiu-Li Zuo, Ya-Fei Yin, Jia-Xin Du, Zhen-Zhen Zhai, Xiao-Zhong Gao, Yan-Qing Li

Journal: Gastrointestinal endoscopy 2017;84(6):917-923.e5

PMID: 27189657

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Image quality can be guaranteed with the conventional dosage of fluorescein sodium in probe-based confocal laser endomicroscopy (pCLE). However, yellow discoloration of the skin seriously affects daily life and simultaneously increases the risk of adverse events such as allergic reactions. The aim of this study was to test whether a lower dosage of fluorescein sodium can provide satisfactory image quality and to compare the diagnostic accuracy of gastric intestinal metaplasia (GIM) through a randomized blind controlled trial.

METHODS

Consecutive patients were randomly assigned to different doses of fluorescein sodium. Image quality was determined by the endoscopists' subjective assessments and signal-to-noise ratio (SNR) assessment systems. Skin discoloration was tested using a neonatal transcutaneous jaundice detector. In addition, consecutive patients with a known or suspected diagnosis of GIM were examined by pCLE with the lower dose and the traditional dose.

RESULTS

Only 0.01 mL/kg dose of 10% fluorescein sodium led to a significant decrease in image quality (P < .05), and a dose of 0.02 mL/kg had the highest SNR value (P < .05). There were no significant differences in skin discoloration between the 0.01 mL/kg and 0.02 mL/kg doses (P = .148) and no statistical difference in the diagnostic accuracy of pCLE for GIM between the 0.02 mL/kg and 0.10 mL/kg doses (P > .05). The kappa values for the correlation between pCLE and histopathology were 0.867 (95% confidence interval, 0.782-0.952) and 0.891 (95% confidence interval, 0.811-0.971).

CONCLUSIONS

The 0.02 mL/kg dose of 10% fluorescein sodium seems to be the best dose for pCLE in the upper GI tract, with comparable image quality with the conventional dose and insignificant skin discoloration. This dose is also very efficient for the diagnosis of GIM.

Address: Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China; Department of Gastroenterology, Weihai Municipal Hospital, Weihai, Shandong, China.; Department of Hepatobiliary Surgery, Weihai Municipal Hospital, Weihai, Shandong, China.; Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, Shandong, China.; Department of Gastroenterology, Dezhou People's Hospital, Dezhou, Shandong, China.; Department of Gastroenterology, Weihai Municipal Hospital, Weihai, Shandong, China.

DOI: 10.1016/j.gie.2016.05.011

Link outs

Free resources

Other Literature Sources:

https://scite.ai/reports/27189657

Subscription / membership required

Full Text Sources:

MeSH Terms: Adult, Aged, Contrast Media, Endoscopy, Gastrointestinal, Feasibility Studies, Female, Fluorescein, Gastrointestinal Tract, Humans, Intravital Microscopy, Male, Metaplasia, Microscopy, Confocal, Middle Aged, Pigmentation Disorders, Signal-To-Noise Ratio, Single-Blind Method, Skin Pigmentation, Young Adult