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Original Article
Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy
Kazuya Inoki, Seiichiro Abe, Yusaku Tanaka, Koji Yamamoto, Daisuke Hihara, Ryoji Ichijima, Yukihiro Nakatani, HsinYu Chen, Hiroyuki Takamaru, Masau Sekiguchi, Masayoshi Yamada, Taku Sakamoto, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Takahisa Matsuda, Yutaka Saito
Clin Endosc 2021;54(3):363-370.   Published online September 8, 2020
DOI: https://doi.org/10.5946/ce.2020.058
AbstractAbstract PDFPubReaderePub
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 the study. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination of the optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by three endoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were not deemed 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 to 0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLE with 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 the upper and lower GI tract.

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  • Prospective assessment of probe‐based confocal laser endomicroscopy under direct cholangioscopic visualization for biliary strictures that could not be definitively diagnosed using endoscopic retrograde cholangiopancreatography (with video)
    Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Ryuichi Watanabe, Ryo Sato, Tomoaki Tashima, Yumi Mashimo
    DEN Open.2025;[Epub]     CrossRef
  • Confocal Laser Endomicroscopy: Enhancing Intraoperative Decision Making in Neurosurgery
    Francesco Carbone, Nicola Pio Fochi, Giuseppe Di Perna, Arthur Wagner, Jürgen Schlegel, Elena Ranieri, Uwe Spetzger, Daniele Armocida, Fabio Cofano, Diego Garbossa, Augusto Leone, Antonio Colamaria
    Diagnostics.2025; 15(4): 499.     CrossRef
  • Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy
    Francesco Vito Mandarino, Silvio Danese, Toshio Uraoka, Adolfo Parra‐Blanco, Yasuharu Maeda, Yutaka Saito, Shin‐Ei Kudo, Michael J. Bourke, Marietta Iacucci
    Digestive Endoscopy.2024; 36(7): 761.     CrossRef
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Special Issue Articles of IDEN 2012
International Digestive Endoscopy Network to Strengthen Network for Lower Gastrointestinal Diseases Including Inflammatory Bowel Disease and Colorectal Cancer
Kwang An Kwon
Clin Endosc 2012;45(3):251-253.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.251
AbstractAbstract PDFPubReaderePub

The International Digestive Endoscopy Network 2012 organized by Korean Society of Gastrointestinal Endoscopy was held at Seoul, Korea on June 9 to 10, 2012, during which invited lectures of world renowned experts on the lower gastrointestinal (GI) tract were given with a wide range of the latest knowledge and novel imaging of inflammatory bowel disease (IBD) and colorectal endoscopic submucosal dissection (ESD). There were very informative five sessions in the lower GI part consisting of: Colonoscopy in IBD; what can we do in 2012?; A look into the bowel beyond colon in IBD; How to estimate the invasion depth of early GI cancer?; No more no man's land: small bowel exploration; and colorectal ESD: can it be a popular procedure?

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Review
Non-Steroidal Anti-Inflammatory Drug-Induced Enteropathy
Yun Jeong Lim, Chang-Hun Yang
Clin Endosc 2012;45(2):138-144.   Published online June 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.2.138
AbstractAbstract PDFPubReaderePub

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs in the world. NSAID-induced lower gastrointestinal (GI) complications are increasing while upper GI complications are decreasing. Lower GI events accounted for 40% of all serious GI events in patients on NSAIDs. Capsule endoscopy and device assisted enteroscopy are available for detection of small intestinal lesions. Capsule endoscopy studies have demonstrated that NSAIDs use in healthy volunteers raised the incidence (55% to 75%) of intestinal damage. It appears that selective cyclooxygenase-2 inhibitors (coxibs) improved upper and lower GI safety based on results of clinical trials. Selective coxibs are still capable of triggering GI adverse events and cardiovascular toxicity issues were the main focus of concerns. Unfortunately, definite strategies are not available to prevent or heal NSAID-induced intestinal injuries. Thus, there is still a strong clinical need for effective drugs with improved safety profiles than the existing NSAIDs.

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A Case of Acute Lower Gastrointestinal Bleeding from Appendiceal Ulcer
Dae Seung Lim, M.D., Sun Moon Kim, M.D., Mi Il Kang, M.D., Young Suk Kim, M.D., Seung Hyun Jung, M.D., Yong Moon Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D., Young Woo Kang, M.D. and Dae Kyung Ko, M.D.*
Korean J Gastrointest Endosc 2007;35(1):42-45.   Published online July 30, 2007
AbstractAbstract PDF
The common causes of acute lower gastrointestinal bleeding include diverticulosis, colonic vascular ectasia, neoplasm and colitis. Acute lower gastrointestinal bleeding from the appendix is a very rare malady and the causes are reported as angiodysplasia, diverticulum, appendicitis and endometriosis. We report here on the case of a 47-year-old man, who was taking enteric coated aspirin, with severe lower gastrointestinal bleeding that was due to appendiceal ulcer. An active bleeding was identified as coming from the appendiceal orifice during colonoscopy. He was treated by simple appendectomy. Histologic evaluation showed ulceration with both acute and chronic inflammation, along with thickened vessel walls in the submucosa of the appendix.
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