Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial

Dunbar, Kerry B.; Okolo, Patrick I.; Montgomery, Elizabeth A.; Canto, Marcia Irene

doi:10.1016/j.gie.2009.02.009

Cited by 212 publications

(125 citation statements)

References 28 publications

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“…This technique also showed good performance for the diagnosis of BE associated neoplasia, with a sensitivity and specificity of 92.9% and 98.4% respectively (49). Moreover, additional studies have shown that the use of eCLE with targeted biopsies has a higher diagnostic yield for BE associated neoplasia compared to standard biopsy protocol, with reduction in the number of biopsies needed (50,51). Real-time microscopic visualization of the mucosa is also achieved with the use of endocytoscopy, however its use has been limited in the management of BE patients due to poor image quality (48).…”

Section: Diagnosis Of Bementioning

confidence: 89%

Optimizing the diagnosis and therapy of Barrett’s esophagus

2017

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Section: Diagnosis Of Bementioning

confidence: 89%

Optimizing the diagnosis and therapy of Barrett’s esophagus

2017

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“…A follow-up cross over study compared routine quadrant biopsies with biopsies targeted by eCLE. The per biopsy diagnostic yield was almost doubled by CLE, and two thirds of patients did not need any biopsy based on normal appearance of their Barrett's segment with CLE [21].…”

Section: Endomicroscopy In the Esophagusmentioning

confidence: 99%

“…Within larger lesions, the most suspicious part can be identified and targeted for physical tissue sampling. In studies, such a concept of microscopically targeted, "smart" biopsies has resulted in fewer biopsies, but higher yield to detect neoplasia in the upper [21] and lower GI tract [22].…”

Section: In Vivo Imaging and Staining Protocolsmentioning

confidence: 99%

Confocal Laser Endomicroscopy: Applications in Clinical and Translational Science—A Comprehensive Review

Goetz

2012

ISRN Pathology

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Confocal laser endomicroscopy (CLE) is a novel tool in the endoscopist's armamentarium. It allows on-site histological information. The ability of gastroenterologists to interpret such microscopic information has been demonstrated in multiple studies from the upper and lower gastrointestinal tract. Recently, the field of application has expanded to provide hepatobiliary and intra-abdominal CLE imaging. CLE allows "smart," targeted biopsies and is able to guide endoscopic interventions. But CLE is also translational in its approach and permits functional imaging that significantly impacts on our understanding of gastrointestinal diseases. Molecular imaging with CLE allows detection and characterization of lesions and may even be used for prediction of response to targeted therapy. This paper provides a comprehensive review over current applications of CLE in clinical applications and translational science.

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“…A better rationale for reimbursing CLE at a higher level may be that it appears to safely reduce the number of biopsies needed for surveillance. The data of Dunbar et al 27 suggest that its added value for Barrett esophagus patients compared to conventional endoscopy could be as high as the charges for 10 endoscopic biopsies. The data of Kiesslich et al 21 suggest that 70 CLE images can substitute for about 30 endoscopic biopsies for cancer surveillance in ulcerative colitis.…”

Section: Limitations Of Confocalmentioning

confidence: 99%

“…Half as many eCLE-targeted biopsies (10 fewer per patient) detected the same number of high-grade lesions as standard surveillance biopsies. 27 The theme that emerges from this and the colonic findings is that CLE has value in decreasing the number of biopsies required. High interobserver agreement has been achieved for diagnosis of dysplasia by CLE in Barrett esophagus, with a k value of 0.83.…”

mentioning

confidence: 92%

Confocal Laser Endomicroscopy: A Primer for Pathologists

Paull¹,

Hyatt²,

Wassef³

et al. 2011

Archives of Pathology &Amp; Laboratory Medicine

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N Context.-The advent of new endoscopic optical techniques is likely to change pathologists' role in diagnosis.Objective.-To describe how confocal laser endomicroscopy (CLE) works, show its advantages and limitations compared to cytohistologic biopsy, and explore how it may affect the practice of pathology.Data Sources.-Literature review.Conclusions.-Confocal laser endomicroscopy is proving its ability to provide histology-like images of tissues in vivo to help avoid risks and costs of conventional biopsies. Confocal imaging restricts light to 1 plane, emulating a paraffin section, and topical or systemic optical contrast agents allow subcellular resolution. New contrast agents could theoretically permit molecular characterization. In vivo imaging has begun to demonstrate novel, dynamic types of diagnostic features. Decreased histologic biopsies can be anticipated for a few scenarios. Significant limitations of CLE include the inability to create a tissue archive for broad molecular classification, suboptimal contrast agents, small fields of view and shallow penetration, paucity of clinical validation studies, and problems with reimbursement. Confocal laser endomicroscopy exposes new opportunities for pathologists: CLE technologies can be exploited in pathology, and diagnostic criteria expanded based on endoscopists' discoveries. Potential synergy exists between CLE and cytology, allowing the low-magnification diagnostic architectural changes by CLE and cytomorphology to emulate the full diagnostic information in a histologic biopsy while providing an archive of material for molecular or immunohistochemical studies. Confocal laser endomicroscopy will decrease some types of biopsies, but offers an opportunity for pathologists to find new ways to provide value and improve patient care.

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Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial

Abstract: Background-The detection of high grade dysplasia and cancer in Barrett's esophagus (BE) can be challenging. Confocal laser endomicroscopy (CLE) allows in vivo visualization of mucosal histology during endoscopy.

Cited by 212 publications

References 28 publications

Optimizing the diagnosis and therapy of Barrett’s esophagus

Optimizing the diagnosis and therapy of Barrett’s esophagus

Confocal Laser Endomicroscopy: Applications in Clinical and Translational Science—A Comprehensive Review

Confocal Laser Endomicroscopy: A Primer for Pathologists

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