Real-Time In Vivo Imaging of Early Mucosal Changes during Ischemia-Reperfusion in Human Jejunum

被引:10
作者
Grootjans, Joep [1 ]
Hameeteman, Wim [2 ]
Masclee, Ad A. [2 ]
van Dam, Ronald M. [1 ]
Buurman, Wim A. [1 ]
Dejong, Cornelis H. C. [1 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Surg, NUTRIM Sch Nutr Toxicol & Metab, Maastricht, Netherlands
[2] Maastricht Univ, Med Ctr, Dept Gastroenterol, NUTRIM Sch Nutr Toxicol & Metab, Maastricht, Netherlands
关键词
ACUTE MESENTERIC ISCHEMIA; INTESTINAL ISCHEMIA; CAPSULE ENDOSCOPY; ORGAN DYSFUNCTION; INJURY; DIAGNOSIS; BARRIER; GUT;
D O I
10.1371/journal.pone.0039638
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background and study aims: Small intestinal ischemia-reperfusion (IR) is a frequent, potentially life threatening phenomenon. There is a lack of non-invasive diagnostic modalities. For many intestinal diseases, visualizing the intestinal mucosa using endoscopy is gold standard. However, limited knowledge exists on small intestinal IR-induced, early mucosal changes. The aims of this study were to investigate endoscopic changes in human jejunum exposed to IR, and to study concordance between endoscopic appearance and histology. Patients and methods: In 23 patients a part of jejunum, to be removed for surgical reasons, was isolated and selectively exposed to ischemia with 0, 30 or 120 minutes of reperfusion. In 3 patients, a videocapsule was inserted in the isolated segment before exposure to IR, to visualize the mucosa. Endoscopic view at several time points was related to histology (Heamatoxylin & Eosin) obtained from 20 patients. Results: Ischemia was characterized by loss of villous structure, mucosal whitening and appearance of punctate lesions. This was related to appearance of subepithelial spaces and breaches in the epithelial lining in the histological view. Early during reperfusion, the lumen filled with IR-damaged, shed cells and VCE showed mucosal erosions, hemorrhage and intraluminal debris. At 60 minutes of reperfusion, the only remaining signs of IR were loss of villous structure and small erosions, indicating rapid mucosal healing. Conclusions: This study shows a unique, real-time in vivo endoscopic view of early mucosal changes during IR of the human small intestine. Future studies should evaluate its usefulness in diagnosis of patients suspected of IR.
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页数:5
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