Collagenous colitis is a kind of microscopic colitis. It is characterized by chronic watery diarrhea
and abdominal pain. The etiology is still unknown. So far, for the diagnose a histological
evaluation was necessary with the presence of thickened subepithelial collagneous bands in the
lamina propria. A new developed endoscope with a confocal laser allows analysing cellular and
subcellular details of the mucosal layer at high resolution in vivo. In this case report we describe
for the first time to diagnose collagenous colitis during ongoing colonoscopy by using this
confocal endomicroscopy. In a 67 year old female patient with typical symptoms the
characteristic histological changes could be identified in the endomicroscopic view. Biopsies
could be targeted to affected areas and endomicroscopic prediction of the presence of collagenous
bands could be confirmed in all targeted biopsies. First endomicroscopic experience in
microscopic colitis could be confirmed in four additional patients. Future prospective studies are
warranted to further evaluate these initial findings. However, collagenous colitis is frequently
missed and endomicroscopy seems to be the ideal tool for accurate diagnosing collagenous colitis
during ongoing endoscopy.
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