Role Of Confocal Laser Endomicroscopy Research Articles

Role of confocal laser endomicroscopy compared to high definition i- scan video bronchoscopy in patients with suspected lung cancer

Abstract Background Lung cancer is the leading cause of cancer-related mortality worldwide. Overall 5-year survival is poor at 15% with little improvement over the last twenty years (1.59 million deaths). Besides effective prevention strategies against the commonest risk factor; tobacco smoking, lung cancer mortality can be reduced if cases are detected and treated early. It is important to detect bronchial carcinoma in situ (CIS) since over 40% of these can develop into invasive cancer. Screening tests using sputum cytology and chest radiograph have been used with limited success Objective to study the diagnostic performance of confocal laser endomicroscopy in comparison to high definition i-scan videobronchoscopy in patients with suspected lung cancer. Patients and Methods The study was performed at Pulmonary diseases hospital in Kobry Elkobba military complex for 2 years since January 2018 to December 2019. The study included 25 patients all had chest CT findings suspicious of lung cancer. Results i-scan findings showed 68% accuracy and 73.3% specificity, and findings of confocal laser endomicroscopy were 92% accuracy and 90% specificity. Conclusion This was the preliminary study establishing patient characteristics in Egypt in the form of a comparison between tow methods of diagnosis of lung cancer. The study showed the higher sensitivity of confocal laser endomicroscopy in the diagnosis of lung cancer approved by the results of the pathological specimens optioned under the visual of confocal laser endomicroscopy in comparison to I-scan method.

Role of confocal laser endomicroscopy compared with high definition i-scan video bronchoscopy in patients with suspected lung cancer

Abstract Background Lung cancer is the one of the most important leading cause of mortality related to cancer worldwide. The 5-year survival is not optimistic with a percentage of 15% with mild improvement along the past 20 years (1.59 million deaths). The best effective and sensitive strategies of prevention is avoiding the common risk factor; tobacco smoking. The mortality of lung cancer can be reduced by early detection and treatment of the cases. Bronchial carcinoma in situ is one of the important stages to detect since over 40% of these can develop into invasive cancer. Sputum cytology and chest imaging have been used as a screening tests with limited success. Objective To study the diagnostic performance of confocal laser endomicroscopy in comparison to high definition i-scan videobronchoscopy in patients with suspected lung cancer. Patients and methods The study was performed at pulmonary diseases hospital in Kobry Elkobba military complex for 2 years since January 2018 to December 2019. The study included 25 patients all had chest CT findings suspicious of lung cancer. Results i-scan findings showed 68% accuracy and 73.3% specificity, and findings of confocal laser endomicroscopy were 92% accuracy and 90% specificity. Conclusion This was a study including patient characteristics in Egypt as a comparison between two methods of diagnosis of lung cancer. The study showed the higher sensitivity of confocal laser endomicroscopy in the diagnosis of lung cancer approved by the results of the pathological specimens optioned under the visual of confocal laser endomicroscopy in comparison with i-scan method.

The Multifaceted Role of Confocal Laser Endomicroscopy in Head and Neck Surgery: Oncologic and Functional Insights.

(1) Background: Confocal laser endomicroscopy (CLE) has emerged as a transformative tool in head and neck surgery, with applications spanning oncologic insights and functional evaluations. This study delves into CLE's potential in these domains. (2) Methods: We performed CLE in head and neck oncologic surgery, focusing on tumor margin identification and precise resection. We also employed CLE for functional assessment in allergic rhinitis, observing real-time mucosal changes during nasal provocation testing. (3) Results: In oncologic surgery, CLE enabled real-time visualization of tumor margins and cellular patterns, aiding resection decisions. In allergic rhinitis assessment, CLE captured dynamic morphological alterations upon allergen exposure, enhancing understanding of mucosal reactions. (4) Conclusions: The integration of CLE with evolving technologies such as deep learning and AI holds promise for enhanced diagnostic accuracy. This study underscores CLE's expansive potential, highlighting its role in guiding surgical choices and illuminating inflammatory processes in the head and neck.

Role of Confocal Laser Endomicroscopy in Early Detection of Upper Gastrointestinal Malignancy in High Risk Patients.

Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results. It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures. The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett's esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy. CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.

The role of confocal laser endomicroscopy in pulmonary medicine.

Accurate diagnosis and subsequent therapeutic options in pulmonary diseases mainly rely on imaging methods and histological assessment. However, imaging examinations are hampered by the limited spatial resolution of images and most procedures that are related to histological assessment are invasive with associated complications. As a result, a high-resolution imaging technology - confocal laser endomicroscopy (CLE), which is at the forefront and enables real-time microscopic visualisation of the morphologies and architectures of tissues or cells - has been developed to resolve the clinical dilemma pertaining to current techniques. The current evidence has shown that CLE has the potential to facilitate advanced diagnostic capabilities, to monitor and to aid the tailored treatment regime for patients with pulmonary diseases, as well as to expand the horizon for unravelling the mechanism and therapeutic targets of pulmonary diseases. In the future, if CLE can be combined with artificial intelligence, early, rapid and accurate diagnosis will be achieved through identifying the images automatically. As promising as this technique may be, further investigations are required before it can enter routine clinical practice.

Role of confocal laser endomicroscopy in patients with early esophageal neoplasia.

Probe-based confocal laser endomicroscopy (pCLE) enables real-time histopathological assessment during endoscopic procedures to evaluate epithelial and subepithelial structures with a 1000x magnification. It may be used in various localizations not only in the digestive tract, but its role in clinical practice is still a matter of discussion. The main advantages of pCLE compared to standard biopsies may be: 1) real-time diagnosis; 2) which may be done by the endoscopist; and 3) a larger evaluated area compared to standard biopsies. In theory, pCLE has the potential to eliminate the need for biopsy. However, pCLE cannot replace standard biopsies at this time, among others, standard forceps biopsies are presently more cost-effective. pCLE may be used to enhance the diagnostic arsenal and improve mucosal visualization and evaluation in patients with Barrett's esophagus (BE), with visible esophageal lesions and in patients undergoing surveillance endoscopy after endoscopic treatment of BE related neoplasia. pCLE requires sufficient training and use of validated classifications systems. At present, the majority of endoscopic centers do not use pCLE routinely and no guidelines recommend its routine use for patients with different esophageal diseases, although pCLE is (in selected indications) reimbursed in some countries. This article describes the principle and performance of pCLE and reviews its use in patients with BE and early esophageal neoplasia.

In vivo assessment of vascular patterns and tumor angiogenesis in colorectal cancer: Role of confocal laser endomicroscopy

In vivo assessment of vascular patterns and tumor angiogenesis in colorectal cancer: Role of confocal laser endomicroscopy

Use of confocal laser endomicroscopy to assess the adequacy of endoscopic treatment of gastrointestinal neoplasia: a systematic review and meta-analysis.

Evaluation of the adequacy of endoscopic mucosal resection (EMR) of gastrointestinal lesions remains challenging by use of conventional endoscopy. Confocal laser endomicroscopy (CLE) is a novel imaging technique, designed to provide in vivo histology, and facilitate diagnosis with real-time intervention. We undertook a systematic review of the available literature, exploring the role of CLE in assuring completeness of EMR of gastrointestinal lesions. The number of pertinent studies is very limited, including only 1 randomized controlled study and 2 prospective comparative case series. Per-lesion meta-analysis showed that the sensitivity of CLE for detection of residual neoplasia was 91% (95% confidence interval, 82.5%-96%) with specificity of 69% (95% confidence interval, 61%-77%), with significant heterogeneity noted in all outcomes. In conclusion, the evidence underpinning the usefulness of CLE in ensuring adequate EMR of gastrointestinal neoplasia is currently very weak, with limited promising results related to gastric and colorectal polyp resections.

A pilot study of the endomicroscopic assessment of tumor extension in Barrett's esophagus-associated neoplasia before endoscopic resection.

Background and study aims: Barrett’s esophagus (BE) – associated neoplasia can be treated endoscopically, but accurate assessment before intervention is challenging. This study aimed to investigate the role of confocal laser endomicroscopy (CLE) as an adjunct in the endoscopic treatment of BE-associated neoplasia by assessing lateral tumor and subsquamous tumor (SST) extension. Patients and methods: In the context of a prospective, single-arm pilot clinical trial, patients referred for endoscopic resection of BE-associated neoplasia (high grade dysplasia and esophageal adenocarcinoma) underwent high definition, white light endoscopy with narrow-band imaging (NBI). Then, CLE mapping of suspected neoplastic lesions was performed by another endoscopist, partially blinded to the previous findings, before the patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), depending on lesion size and anticipated histology. Results: In 7 of 38 patients (18 %), CLE revealed additional neoplastic tissue compared with prior white light endoscopy and NBI: 2 concomitant lesions, 2 cases of lateral tumor extension within the Barrett’s epithelium, and 3 cases of previously undetected SST extension. Overall, en bloc resection (tumor-free lateral margin) was achieved in 28 of 34 neoplastic lesions (82 %), and complete resection (tumor-free lateral and basal margins) in 21 of 34 neoplastic lesions (62 %). Conclusions: CLE-assisted endoscopic resection of BE-associated neoplasia was safe and effective in this study, as proved by a high additional diagnostic yield of CLE (including visualization of occult SST extension) and a favorable rate of en bloc resection. The clinical value of CLE for assisting endoscopic therapy of BE-associated neoplasia deserves further evaluation in randomized controlled trials.

Su1143 The Role of Confocal Laser Endomicroscopy in the Management of Patients With Biliary Strictures: A Consensus Report Based on Clinical Evidence

Su1143 The Role of Confocal Laser Endomicroscopy in the Management of Patients With Biliary Strictures: A Consensus Report Based on Clinical Evidence

Tu1078 The Role of Confocal Laser Endomicroscopy in the Management of Patients With Barrett's Esophagus: A Clinical Evidence-Based Consensus Report

Background: Abdominal pain is a common reason for ER visits. Acid suppression therapy (AST) using proton pump inhibitors and H2-blockers is commonly prescribed in ER for abdominal pain. As inappropriate use of AST can contribute to drug interactions, pneumonia, and increased health care expenditure, we wanted to look for factors which influence prescribing patterns of AST in ER. Objectives: To evaluate if age, gender differences, severity of abdominal pain and length of ER stay influence prescription of acid suppression therapy (AST) in patients presenting to ER with abdominal pain. Methods: We analyzed the limited access dataset of National Hospital Ambulatory Medical Care Survey (2006 to 2009) for ER visits. We included all patients above 15 years of age presenting to ER with upper abdominal pain. We calculated and compared AST prescription rates based on age, gender, severity of pain and length of ER visit. Statistical analysis was done using multivariate logistic regression. Results: There were a total of 1, 12,810 patient visits. Of these, 11,496 visits were for abdominal pain consisting of 70% women and 30% men. Men were 36% more likely to receive AST compared to women (OR 1.35 95% CI 1.18 to 1.57). Patients in age group 45-64 years were more likely to receive AST compared to younger age groups (OR 1.32 CI 1.11 to 1.56). Patients with ER visit longer than 9 hours were more likely to receive AST compared to shorter ER visits (OR 1.82 CI 1.43 to 2.30). Patients with severe abdominal pain were more likely to receive AST compared to patients with milder degree of pain (OR 1.37 CI 1.08 to 1.74). Conclusion: Age, gender differences, length of ER visit and severity of abdominal pain have significant impact on the prescription of AST for the treatment of abdominal pain in ER. The higher prevalence of gastritis/ ulcers in men and presence of additional sources of abdominal pain in women could explain the higher prescription rate in men. Middle aged patients have higher AST prescription rate which probably reflects the higher prevalence of upper GI pathology as patients get older. A tendency to prescribe AST when a definite diagnosis is not reached or when pain is refractory could explain the higher prescription rates in patients with longer ER visits and severe abdominal pain. Further studies are needed to investigate and frame guidelines for appropriate use of AST.

Confocal Endomicroscopy of Colorectal Polyps

Confocal laser endomicroscopy (CLE) is one of several novel methods that provide real-time, high-resolution imaging at a micron scale via endoscopes. CLE has the potential to be a disruptive technology in that it can change the current algorithms that depend on biopsy to perform surveillance of high-risk conditions. Furthermore, it allows on-table decision making that has the potential to guide therapy in real time and reduce the need for repeated procedures. CLE and related technologies are often termed “virtual biopsy” as they simulate the images seen in traditional histology. However, the imaging of living tissue allows more than just pragmatic convenience; it also allows imaging of living tissue such as active capillary circulation, cellular death, and vascular and endothelial translocation, thus extending beyond what is capable in traditional biopsy. Immediate potential applications of CLE are to guide biopsy sampling in Barrett's esophagus and inflammatory bowel disease surveillance, evaluation of colorectal polyps, and intraductal imaging of the pancreas and bile duct. Data on these applications is rapidly emerging, and more is needed to clearly demonstrate the optimal applications of CLE. In this paper, we will focus on the role of CLE as applied to colorectal polyps detected during colonoscopy.

How confocal laser endomicroscopy can help us in diagnosing gastric lymphomas?

Primary gastric diffuse large cell lymphoma is one of the most common extranodal lymphomas of the gastrointestinal system. Diagnosing gastrointestinal lymphomas can be difficult, since there is no pathognomonic sign in endoscopy to distinguish it from other malignancies. In some cases biopsy can be non-diagnostic. Therefore, multiple endoscopic examinations and biopsies can be necessary. With using confocal endomicroscopy, histology of the tissue can be seen in vivo and a range of diseases can be identified by using this technique. We are presenting a case, which is diagnosed as primary gastric diffuse large cell lymphoma during the evaluation of erythema nodosum etiology. We want to emphasize the role of confocal laser endomicroscopy for in vivo diagnosis of gastric lymphoma and directing the endoscopist for sampling the diseased mucosa. Confocal endomicroscopy decreases non-diagnostic rates in endoscopic biopsy and can be performed successfully in cases of gastric lymphoma. Pit patterns of gastric lymphoma, ring cell gastric carcinoma and gastric adenocarcinoma are similar. To best of our knowledge, this case is the fifth case of confocal laser endomicroscopy aided in diagnosing gastric lymphomas (Tab. 1, Fig. 2, Ref. 13).