Digestive Diseases and Sciences

, Volume 58, Issue 1, pp 188–193

Improved Detection of Incident Dysplasia by Probe-Based Confocal Laser Endomicroscopy in a Barrett’s Esophagus Surveillance Program

Authors

    • Endoscopia DigestivaNuovo Ospedale S. Agostino
  • Marzio Frazzoni
    • Fisiopatologia Digestiva Nuovo Ospedale S. Agostino
  • Emanuele Dabizzi
    • Endoscopia DigestivaNuovo Ospedale S. Agostino
  • Flavia Pigò
    • Endoscopia DigestivaNuovo Ospedale S. Agostino
  • Luisa Losi
    • Anatomia Patologica Ospedale Policlinico
  • Mauro Manno
    • Endoscopia DigestivaNuovo Ospedale S. Agostino
  • Raffaele Manta
    • Endoscopia DigestivaNuovo Ospedale S. Agostino
  • Gabrio Bassotti
    • Clinica di Gastroenterologia ed Epatologia
  • Rita Conigliaro
    • Endoscopia DigestivaNuovo Ospedale S. Agostino
Original Article

DOI: 10.1007/s10620-012-2332-z

Cite this article as:
Bertani, H., Frazzoni, M., Dabizzi, E. et al. Dig Dis Sci (2013) 58: 188. doi:10.1007/s10620-012-2332-z

Abstract

Background

Probe-based confocal laser endomicroscopy (pCLE) is a new technique allowing in vivo detection of neoplastic tissue using a standard endoscope.

Aims

Our aim was to compare the incident dysplasia detection rate of biopsies obtained by high-definition white light endoscopy (HD-WLE) or by pCLE in a cohort of patients with Barrett’s esophagus (BE) participating in a surveillance program.

Methods

Fifty of 100 patients underwent pCLE in addition to HD-WLE. Four-quadrant biopsy specimens according to the Seattle biopsy protocol were obtained in all patients to ensure standard-of-care. Diagnosis of dysplasia/neoplasia was made by a blinded gastrointestinal pathologist.

Results

Incident high-grade dysplasia (HGD) and low-grade dysplasia (LGD) were diagnosed in 3/100 and in 16/100 cases. In the HD-WLE group, areas suspicious for neoplasia were not observed and dysplasia was diagnosed in 5/50 (10 %) patients (one with HGD). In the pCLE group, areas suspicious for neoplasia were observed by pCLE in 21/50 (42 %) patients; dysplasia was confirmed in 14 cases (28 %) (two with HGD). The dysplasia detection rate was significantly higher in the pCLE group than in the HD-WLE group (P = 0.04). The sensitivity, specificity, positive and negative predictive values of pCLE for dysplasia were 100, 83, 67, and 100 %, respectively.

Conclusions

Incident dysplasia can be more frequently detected by pCLE than by HD-WLE in BE. The higher dysplasia detection rate provided by pCLE could improve the efficacy of BE surveillance programs.

Keywords

Confocal laser endomicroscopy Barrett’s esophagus Esophageal dysplasia Esophageal adenocarcinoma

Copyright information

© Springer Science+Business Media, LLC 2012