Confocal laser endomicroscopy for the diagnosis of diversion colitis.

Confocal laser endomicroscopy (CLE) and virtual chromoendoscopy (VCE) are advanced endoscopic imaging techniques. i-Scan (Pentax, Japan) is a contrast-enhancing computed program [1], while CLE enables in vivo histological examination [2,3]. Studies from our group described the diagnostic utility of CLE and VCE, such as for Crohn’s disease [4–6]. However, data regarding the applicability of VCE and CLE for the diagnosis of diversion colitis have not been provided so far. Here, we describe the case of a 33-yearold woman who underwent an ileocecal resection and colorectal diversion 4 years previously because of a complicated ileocecal and rectal endometriosis with poor postoperative wound healing and the occurrence of a rectovaginal fistula. She reported diarrheic stools, which were still abundant (12–15 occurrences of diarrhea/day) even after a therapeutic attempt with high-dose steroids and antibiotics. High definition endoscopy (EPK-i, Pentax, Japan) showed a highly inflamed and friable mucosa with large ulcerations, loss of haustration, spontaneous bleeding, and mucus mixed with pus in the lumen (●" Fig.1a) of the diverted colorectum. Subsequent examination of the same area by CLE (Pentax EC-3870 CIFK, Japan) upon intravenous administration of fluorescein as a contrast agent, revealed a pronounced crypt rarefaction, hypervascularization with moderate leakage, and typical crypt abscesses (●" Fig.1b). Subsequent histopathological evaluation (hematoxylin and eosin stain) of conven-