Endoscopy 2008; 40(7): 554-562
DOI: 10.1055/s-2008-1077296
Original article

© Georg Thieme Verlag KG Stuttgart · New York

In vivo confocal laser endomicroscopy of the human liver: a novel method for assessing liver microarchitecture in real time

M.  Goetz1 , R.  Kiesslich1 , H.-P.  Dienes2 , U.  Drebber2 , E.  Murr3 , A.  Hoffman1 , S.  Kanzler1 , P.  R.  Galle1 , P.  Delaney3 , M.  F.  Neurath1
  • 1First Medical Clinic, University of Mainz, Mainz, Germany
  • 2Department of Pathology, University of Cologne, Cologne, Germany
  • 3Optiscan Pty., Ltd., Notting Hill, Victoria, Australia
Further Information

Publication History

submitted 26 October 2007

accepted after revision 20 March 2008

Publication Date:
07 July 2008 (online)

Background and study aims: Confocal endomicroscopy is a unique novel tool for in vivo histology in humans. Due to limitations imposed by the form of the equipment and by sterilization workflows, its use has been limited to the gastrointestinal tract so far. We have developed a rigid miniaturized probe for confocal endomicroscopy of the human liver during laparoscopy.

Patients and methods: To assess the feasibility and potential clinical value of this new system (diameter 6.3 mm), 25 patients with liver disease were examined during routine minilaparoscopy under conscious sedation.

Results: Subsurface serial images (from surface to 250 µm) were generated in real time after fluorescein injection, permitting visualization of hepatocytes, bile ducts, sinusoids, and collagen fibers in vivo. Typical appearances of liver diseases were identified. Confocal diagnosis of moderate-to-severe steatosis and pericellular fibrosis correlated well with histopathologic analysis of subsequent biopsies (83.3 % and 84.6 %, respectively). In addition, intra-abdominal structures such as gallbladder, omentum, and stomach were analyzed by endomicroscopy.

Conclusions: A miniaturized imaging system for confocal laparoscopy allowed in vivo microscopic analysis of healthy and diseased human liver for the first time during ongoing minilaparoscopy. Although such in vivo imaging does not yet compete with conventional histopathology, this novel confocal laparoscopy system may be of future relevance for immediate morphodynamic analysis in liver disease and the targeting of biopsies in vivo.

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M. Goetz, MD

First Medical Clinic

University of Mainz

Langenbeckstr. 1

55131 Mainz

Germany

Fax: +49-6131-175552

Email: mgoetz@mail.uni-mainz.de