Probe confocal laser endomicroscopy in the therapeutic endoscopic management of Barrett's dysplasia.

Details

Serval ID
serval:BIB_B4EBB5889507
Type
Article: article from journal or magazin.
Collection
Publications
Title
Probe confocal laser endomicroscopy in the therapeutic endoscopic management of Barrett's dysplasia.
Journal
Annals of gastroenterology
Author(s)
Caillol F., Godat S., Poizat F., Auttret A., Pesenti C., Bories E., Ratone J.P., Giovannini M.
ISSN
1108-7471 (Print)
ISSN-L
1108-7471
Publication state
Published
Issued date
2017
Peer-reviewed
Oui
Volume
30
Number
3
Pages
295-301
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Endoscopic management of Barrett's esophagus (BE) depends on the histological stage of BE and includes the following: follow up, endotherapy with thermal ablation, and piecemeal or monobloc endoscopic resection (ER). We know that biopsies are unreliable in 20-75% of cases. The aim of our study was to evaluate the efficiency of probe confocal laser endomicroscopy (pCLE) in the diagnosis of the histological stage of BE, compared with the final histological results after ER.
This retrospective study was based on a prospective registry of patients referred for management of BE-associated dysplasia. The inclusion criteria were dysplasia associated with BE on pre-resection biopsy and endoscopic resection of the examined areas. CLE examinations (pCLEs) were performed using the Gastroflex <sup>®</sup> probe (Maunakea company). ER was sufficient to ensure that the target area was resected. The following four potential diagnoses were considered: normal or inflammatory mucosa, metaplasia (BE), low-grade dysplasia (LGD), and high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC).
The sensitivity, specificity, and accuracy in the detection of HGD/EAC were 92.9%, 71.4% and 80% for pCLE, and 78.6%, 61.9%, and 68.6% for histological biopsy, respectively. The differences in favor of pCLE were not statistically significant (P=0.2); however, in 13 patients with irregularities of the mucosa without elevated or depressed lesions (2 HGD/EAC and 11 non-HGD/EAC), pCLE led to positive redirection of therapy in 70% (9/13) of cases.
In the absence of visible lesions, pCLE appears to lead to correct diagnoses and to aid real-time decisions regarding therapeutic management.
Keywords
Barrett’s esophagus, Probe confocal laser endomicroscopy, endoscopic resection
Pubmed
Web of science
Open Access
Yes
Create date
07/10/2019 14:24
Last modification date
01/11/2019 6:26
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