The Application of Probe-Based Confocal Laser Endomicroscopy as a Diagnostic Tool in Choledochoscopic Gallbladder-Preserving Surgery

Abstract

Background and Aims: Choledochoscopic gallbladder-preserving surgery（CGPS） has the advantage of treating benign gallbladder diseases on the premise of gallbladder preservation. However, it has no reliable preoperative diagnosis if the gallbladder is benign. Probe-based confocal laser endomicroscopy (pCLE) can obtain real-time and clear endoscopic images at the cell level in vivo.It is widely used in the diagnosis of digestive system diseases，but not in gallbladder diseases yet. We applied these two technologies in a complementary way into the diagnosis of gallbladder diseases and thereby lifted the reliability of CGPS. Methods: We retrospectively analyzed the total twenty-eight patients with the indication of CGPS with introparative pCLE scan referred to The Second Affiliated Hospital of Baotou Medical College between October 2019 and July 2020. The intraoperative pCLE results were compared with the postoperative pathology in various gallbladder diseases. Results: We compared the intraoperative pCLE diagnosis with the postoperative pathological diagnosis, and found a complete match without exception in both sensitivity and specificity. Conclusions: Based on our investigation, pCLE can provide the same accuracy as the tranditional pathology in the diagnosis of gallbladder diseases with the additional advantages like noninvasive, real-time, and instancy.This study serves to validate the correlation between CLE and histology. It holds a broad prospect in the application of pCLE as an intraoperative diagnosis in CGPS.

Diagnostic Challenges in Endoscopy

“…Biopsy is not routinely performed for suspicious gallbladder polyps. Tang et al [5] described a novel probe-based confocal laser endomicroscopy that can be used to differentiate benign and malignant gallbladder polyps. We hope that readers of Digestive Diseases will find this volume an interesting and useful addition to the existing literature on diagnostic challenges in endoscopy.…”