Confocal Laser Endomicroscopy for in-vivo Diagnosis of Barrett's Esophagus and Associated Neoplasia: An Ongoing Prospective Study

Abstract

Background and Aim: Barrett's esophagus is widely accepted as a premalignant lesion. However, the diagnosis and management are controversial. Recent technical improvements in the real-time recognition of intestinal metaplasia or dysplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows the analysis of living cells during ongoing endoscopy, but only a single study has been published on this topic. The aim of the present study was to assess the suitability of confocal laser endomicroscopy for the in-vivo diagnosis of Barrett's esophagus and associated neoplasia. Methods: Thirty-nine consecutive patients with reflux symptoms or surveillance endoscopy for known Barrett's esophagus were studied. Fluorescein-aided endomicroscopy (EC-3870CIFK; Pentax, Tokyo, Japan) was carried out in a circular fashion, every 1 to 2 cm, on the whole columnar-lined distal esophagus. If the Z-line was regular, endomicroscopy was performed at this level over the whole circumference. Targeted biopsies were taken. Confocal images were classified according to the Kiesslich Confocal Barrett Classification. Endomicroscopic and histological findings were compared. Results: Four patients with reflux symptoms and 35 patients known for Barrett's esophagus (3 previously treated with argon plasma coagulation) were studied. At endoscopy, a columnar-lined distal esophagus was observed in 35 patients (3 with reflux symptoms and 32 known for Barrett's esophagus) and a regular Z-line in 4 (1 with reflux symptoms and in the 3 previously treated for Barrett's esophagus). Barrett's esophagus and associated neoplasia was diagnosed in 31 patients at endomicroscopy and in 28 at histological diagnosis. Correlation between endomicroscopic findings and histology are shown in the table. Barrett's esophagus and associated neoplasia could be predicted with a sensitivity of 96.4%. The agreement between endomicroscopic and histological results was substantial (κ=0.74). Conclusions. Confocal laser endomicroscopy is able to provide in-vivo diagnosis of Barrett's esophagus and associated neoplasia. Because of the higher possibility of studying larger surface areas of the mucosa, confocal laser endomicroscopy may lead to significant improvements in the in-vivo screening and surveillance of Barrett's esophagus. Tabled 1 Histology Endomicroscopy Normal Barrett Gastric-type Neoplasia Total Normal 4 0 0 0 4 Barrett 1 20 3 0 24 Gastric-type 0 1 3 0 4 Neoplasia 0 2 0 5 7 Total 5 23 6 5 39 Open table in a new tab