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

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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.

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Acknowledgments

This study was conducted without any financial support.

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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Authors and Affiliations

  1. Endoscopia Digestiva, Nuovo Ospedale S. Agostino, Viale Giardini 1355, Modena, Italy

    Helga Bertani, Emanuele Dabizzi, Flavia Pigò, Mauro Manno, Raffaele Manta & Rita Conigliaro

  2. Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy

    Marzio Frazzoni

  3. Anatomia Patologica, Ospedale Policlinico, Modena, Italy

    Luisa Losi

  4. Clinica di Gastroenterologia ed Epatologia, Perugia, Italy

    Gabrio Bassotti

Authors
  1. Helga Bertani
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  2. Marzio Frazzoni
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  3. Emanuele Dabizzi
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  4. Flavia Pigò
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  5. Luisa Losi
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  6. Mauro Manno
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  7. Raffaele Manta
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  8. Gabrio Bassotti
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  9. Rita Conigliaro
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Corresponding author

Correspondence to Helga Bertani.

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Bertani, H., Frazzoni, M., Dabizzi, E. et al. Improved Detection of Incident Dysplasia by Probe-Based Confocal Laser Endomicroscopy in a Barrett’s Esophagus Surveillance Program. Dig Dis Sci 58, 188–193 (2013). https://doi.org/10.1007/s10620-012-2332-z

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  • DOI: https://doi.org/10.1007/s10620-012-2332-z

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