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 endomicroscopyBarrett’s esophagusEsophageal dysplasiaEsophageal adenocarcinoma

Copyright information

© Springer Science+Business Media, LLC 2012