Abstract
Many endoscopic imaging modalities have been developed and introduced into clinical practice to enhance the diagnostic capabilities of upper endoscopy. In the past, detection of dysplasia and carcinoma of esophagus had been dependent on biopsies taken during standard white-light endoscopy (WLE). Recently high-resolution (HR) endoscopy enables us to visualize esophageal mucosa but resolution for glandular structures and cells is still low. Probe-based confocal laser endomicroscopy (pCLE) is a new promising diagnostic technique by which details of glandular and vascular structures of mucosal layer can be observed. However, the clinical utility of this new diagnostic tool has not yet been fully explored in a clinical setting. In this paper we will highlight this new technique for detection of esophageal dysplasia and carcinoma from a clinical practice perspective.
Highlights
Esophageal adenocarcinoma has the fastest growing incidence rate (300% increase over the past 4 decades) [1,2,3], and the risk of patients with Barrett’s Esophagus (BE) of developing adenocarcinoma is 30–120 times greater
The currently accepted paradigm correlates the risk of progression to the grade of dysplasia as there is evidence that progression occurs in an orderly fashion from no dysplasia to low-grade dysplasia (LGD) to high-grade dysplasia (HGD) followed by early esophageal adenocarcinoma [5]
Since BE is considered the most important risk factor for the development of esophageal adenocarcinoma, assuming that the detection of mucosal dysplasia is critically important in patients with Barrett’s oesophagus, because early diagnosis can prevent the progression to invasive carcinoma, international societies of gastrointestinal diseases suggest keeping patients in endoscopy surveillance program [5,6,7]
Summary
Esophageal adenocarcinoma has the fastest growing incidence rate (300% increase over the past 4 decades) [1,2,3], and the risk of patients with Barrett’s Esophagus (BE) of developing adenocarcinoma is 30–120 times greater. A multiple biopsies protocol could interfere with therapeutic steps; endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) could be more difficult without adequate “lifting sign” due to scar tissue after repeated biopsies Another important limitation of histology is that it is a postmortem analysis and it is not able to give us information about in vivo processes (blood flow). This system can be used through the working channel of any standard endoscope (colonoscope, gastroscope, cholangioscope, bronchoscope, and ureteroscop, etc) The advantage of this probe-based CLE is the versatility of the system and the possibility to combine it with other advanced “red flag” imaging modalities such as virtual chromoendoscopy or magnification. Mauna Kea has developed a postacquisition -developed software (“mosaicing”) to paste images together and to obtain images similar to histology specimen
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