Value Of Confocal Laser Endomicroscopy Research Articles

The diagnostic value of confocal laser endomicroscopy for gastric cancer and precancerous lesions among Asian population: a system review and meta-analysis

Objective: The objective of this study is to evaluate the diagnostic value of confocal laser endomicroscopy (CLE) in detection of gastric cancer (GC), gastric intraepithelial metaplasia (GIM), and gastric intraepithelial neoplasia (GIN) lesions.Method: PubMed, the Cochrane Library, and Wangfang databases were searched to include eligible articles about CLE in detection of gastric lesions. After study selection, quality assessment and data extraction conducted by two reviewers independently, meta-analysis was performed by Meta-Disc 1.4. The pooled sensitivity and specificity was calculated, receiver operating characteristic (ROC) curve was constructed, and the area under ROC curve (AUC) was calculated.Results: Twenty-three studies evaluating the diagnostic value of CLE were included. For the diagnosis of GC lesions, the pooled sensitivity, specificity, and AUC were 91% (88–94%), 99% (99–99%), and 0.9513, respectively. For the diagnosis of lesions, the pooled sensitivity, specificity, and AUC were 92% (90–94%), 97% (96–98%), and 0.9774, respectively. For the diagnosis of GIN lesions, the pooled sensitivity, specificity and AUC were 81% (75–85%), 98% (97–98%), and 0.9204, respectively.Conclusions: CLE can provide an accurate diagnosis with high sensitivity and specificity for GC, GIM, and GIN lesions. The results should be confirmed by well-designed, multi-centered, randomized controlled, and double blinded trials with large samples.

Barrett's esophagus: progression to adenocarcinoma and markers

The following on progression to adenocarcinoma and markers of Barrett's esophagus includes commentariess on the expression of claudin 4 in Barrett's adenocarcinoma; the role of acid and bile salts; the role of insulin-like growth factor; the value of reactive oxygen species; the importance of abnormal methylation; genetic alterations in stromal cells and genomic changes in the epithelial cells; the value of confocal laser endomicroscopy for the subsurface analysis of the mucosa; indications for statins as adjuvant chemotherapeutic agent; the sequence of molecular events in malignant progression in Barrett's mucosa; and the value of the macroscopic markers and of p53 mutations.

Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions

BackgroundThe identification of gastric superficial cancerous lesions based on conventional white-light endoscopy (WLE) is challenging, and histological analysis remains the ‘gold standard’ for the final diagnosis. Confocal laser endomicroscopy (CLE)...

The diagnostic value of confocal laser endomicroscopy in colorectal polyps

Objective To analyze endoscopic histological characters and establish diagnostic standards of colorectal polyps with confocal laser endomicroscopy (CLE) examination and to explore the diagnostic value of the CLE in adenomatous polyps and non-adenomatous polyps. Methods From June to December in 2009, 90 patients were recruited in this study, which included 40 pathologically confirmed colorectal polyps patients (total 48 colon and rectal polyps) and 50 patients for prospective study (total 106 colon rectal polyps). At same time 10 spots of normal mucosa was taken for comparison. Firstly the CLE images of 48 pathologically confirmed colorectal polyps (22 adenomatous polyps and 26 non-adenomatous polyps) were analyzed, and the diagnosis criteria for distinguishing adenomatous polyps and non-adenomatous polyps was established with CLE. Then according to the criteria, 106 colorectal polyps underwent prospective diagnosis with CLE. Finally, the CLE diagnosis result was compared with pathologically result to evaluate the diagnosis efficiency of CLE. Results In the 48 colorectal polyps of 40 pathologically confirmed colorectal polyps patients, there were 22 adenomatous polyps and 26 non-adenomatous polyps. The sensitivity, specificity and accuracy of CLE in adenomatous polyps diagnosis were 94. 0%, 92. 9%, and 93. 4%, respectively. The positive predictive value was 92.2% and the negative predictive value was 94.5%. The sensitivity, specificity and accuracy of CLE in non-adenomatous polyps diagnosis were 92. 9%, 94.0%, and 93. 4%respectively, the positive predictive value was 94.5% and the negative predictive value was 92.2%.The coherence of CLE and histopathology in adenomatous polyps diagnosis was pretty good (Kappa=0. 893). Conclusion The accuracy of CLE in adenomatous polyps and non-adenomatous polyps differential diagnosis was high, and the coherence with histopathology diagnosis was good, which provided experience for further detection of early rectal precancerous. Key words: Microscopy,confocal; Intestinal polyps; Diagnosis; Evaluation studies

The value of confocal laser endomicroscopy for diagnosis of helicobacter pylori infection

Objective To investigate the value of fluorescin-aided confocal laser endomicroscopy (CLE) for diagnosis of helicobacter pylori (Hp) infection. Methods From June 2009 to November 2009, patients undergone gastric endoscope examination with upper gastrointestinal symptoms (upper abdominal discomfort, abdominal distension, satiation, acid reflux and eructation) or screened for gastric cancer were enrolled. The gastric mucosa CLE image data of twenty diagnosed Hp positive patients and 10 Hp negative patients was analyzed retrospectively. By comparing with histological image of targeted biopsy tissue, the CLE diagnostic criteria for Hp infection were established. In the prospective study, CLE diagnose result was compared with Hp tested result. The consistency of CLE diagnostic criteria in different observers was also analyzed. The CLE image data with histopathology result were compared accordingly. Results Total 72 patients were enrolled in the prospective study,of 34 Hp positive patients, 31 patients were correctly diagnosed by CLE. The accuracy, sensitivity and specificity of CLE diagnosis were 88.9%, 91.2 and 86.8% respectively. CLE image displaying fluorescin leakage and cell shedding was the highest specificity for Hp infection diagnosis, (97.4 %);fluorescin leakage plus gastric pits distortion and cell edema was the highest sensitivity (88. 2%). The consistency of CLE diagnostic criteria in different observers was high (Kappa value 0. 72, 0.87). The CLE image of Hp infection was highly correlated with inflammation activity (P＜0. 001). Conclusion CLE can accurately distinguish normal mucosa from Hp infected mucosa at the cellular level. The diagnostic value for Hp infection was reliable. Key words: Endoscopy, gastrointestinal; Helicobacter pylori; Pathology

Clinical value of confocal laser endomicroscopy in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions

Objective To assess the value of confocal laser endomieroscopy (CLE) in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Methods CLE examination was performed in 41 patients who needed further examination because of lesions in esophagus during July 2008 to April 2009. The diagnosis was made based on the features of esophageal squamous cells which was defined as low grade intraepithelial neoplasia(LGIN), high grade intraepithelial neoplasia (HGIN) and early esophageal squamous cell carcinoma (EC). Biopsy specimens were taken precisely matched to the CLE imaging sites. The result was compared with that of histopathology. Results There were 7281 eonfocal images obtained from 60 target lesions in 41 patients. The sensitivity, specificity and accuracy of CLE were 75.0%, 88.6% and 85.0% in diagnosis of LGIN, respectively, 85.7% ,92.3% and 90.0% in diagnosis of HGIN, respectively,and 88.9% ,96.1% and 95.0%, in diagnosis of EC,respectively. Conclusions It is an effective method for diagnosis of esophageal neoplastic lesions using CLE, which has high accuracy in diagnosis of HGIN and early esophageal cancer. Key words: Esophageal neoplasms; Endomicroscopy, confocal; Intraepithelial neoplasia

T1620: Endomicroscopy Is Able to Identify Superficial but Not Deep Intestinal Metaplasia of the Gastric Mucosa

Patients with atrophic gastritis and intestinal metaplasia (IM) face an increased risk for gastric cancer. The presence of IM can macroscopically not be visualized. Thus, aim of the current study was to investigate the value of confocal laser endomicroscopy or intensive histological mapping for diagnosing intestinal metaplasia.

Confocal laser endomicroscopy for differential diagnosis of gastric ulcer

Objective To estimate the value of confocal laser endomicroscopy (CLE)for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The eonfocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopathological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83.54% and 85.92%, respectively, with positive predictive value of 86.84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53.57% and 88.52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89.26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88.37% and 93.46%, respectively, with positive predictive value of 84.44 % and negative predictive value of 95.24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased. Key words: Gastric ulcer; Stomach neoplasms; Microscopy; confocal; Diagnosis

Microscopic Changes in Non Erosive Reflux Disease (NERD) Can Be Diagnosed During Ongoing Endoscopy By Confocal Laser Endomicroscopy (CLE)

Introduction: Non erosive reflux disease (NERD) is the most frequent endoscopic finding in patients with gastroesophageal reflux disease (GERD). NERD is histological characterised by elongated papillae, basal cell proliferation and dilated intercellular spaces within the squamous cell epithelium in the distal esophagus. Aim of the current study was to investigate the value of confocal laser endomicroscopy for diagnosing microscopic changes in patients with NERD during ongoing upper endoscopy. Methods: Patients with reflux symptoms scheduled for upper endoscopy were examined with the newly developed confocal laser endoscope (Pentax, Tokyo, EC-3870CIFK). Fluorescein was applied intravenously to enable confocal endomicroscopy of the esophageal mucosa (0-250μm). Confocal images from macroscopic normal apparent mucosa were obtained from every quadrant at the Z-Line and 2 cm above. Confocal image data were collected at a scan rate of 1.6 sec/frames (1024 × 1024 pixels) using an optical slice thickness of 7μm (lateral resolution ≤ 1 μm). The degree of dilated intercellular spaces as well as the amount of capillary loops within the upper third of the mucosal layer was graduated during ongoing endoscopy. Results: 68 patients with GERD were included. 38 patients had to be excluded due to the presence of esophagitis or Barrett's epithelium. In 30 patients cellular and vascular changes within the distal part of the esophagus could be visualised in vivo at high resolution. The capillary loops within elongated papillae were readily visible due to the high contrast of fluorescein and the absence of vasculature within squamous cell epithelium. More than 5 capillary loops within the endomicroscopic field of view (500 × 500 μm) and dilated intercellular spaces (≥ 7 μm) predicted microscopic changes with a sensitivity of 94.9% and specificity of 85.4%, respectively (accuracy 91.7%). Conclusions: Confocal laser endomicroscopy can be used to identify microscopic changes in patients with NERD during ongoing upper endoscopy. Microscopic changes are often located at the 3 o'clock position 2cm above the Z-line. CLE enables targeted biopsies and may help to accurately diagnose patients with NERD and analyze the effect of PPI therapy on microscopic changes in patients with NERD in future studies.