Confocal Laser Endomicroscopy in Barrett’s Esophagus: Is It a Clinical Resource or Still a Research Procedure?

Abstract

Confocal laser endomicroscopy (CLE) is a novel endoscopic imaging modality, providing electronic microscopy images, 1000-fold magnified, thus enabling the endoscopist to obtain real-time in vivo histologic images during conventional endoscopic examinations. White-light endoscopy (WLE), for example, is usually unable to correctly characterize and diagnose pre-neoplastic lesions. In this regard, CLE showed potential advantages in the diagnosis and management of Barrett’s esophagus (BE) and early esophageal cancer. Several studies focused on the possibility to implement the use of CLE into routine clinical management of BE and mucosal dysplasia; its role has been investigated, other than as a red flag technique, also as a potential tool to be used in the surveillance and therapy of Barrett’s esophagus. Perhaps the use of CLE is still far away from routine clinical practice; nevertheless, preliminary experiences seem to be promising and even better outcomes are likely to be achieved with the improvement in technology and wider agreement in confocal imaging interpretation among endoscopists. The chapter will address technical aspects of confocal laser endomicroscopy, as well as the state of the art of CLE in the management of Barrett’s esophagus; current limitations and future perspectives will also be discussed.