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Surgical Endoscopy

, Volume 25, Issue 6, pp 1933–1938 | Cite as

Confocal endomicroscopy for in vivo prediction of completeness after endoscopic mucosal resection

  • Rui Ji
  • Xiu-Li Zuo
  • Chang-Qing Li
  • Cheng-Jun Zhou
  • Yan-Qing Li
Article

Abstract

Background

Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplastic lesions. Residual neoplastic tissue of the resection interface is difficult to detect by conventional endoscopy. The aim of this study is to assess the efficacy of confocal laser endomicroscopy (CLE) in predicting complete resection margins after EMR.

Methods

EMR was performed by using cap-assisted or “inject and cut” resection technique. Two weeks after EMR, the circumferential margins of the defect were inspected by using CLE, and completeness of excision was predicted from the CLE image. Additional EMR was performed if necessary. In vivo CLE diagnosis was validated against final histopathology.

Results

Twenty-seven lesions were removed by EMR in 27 patients. After excluding 3 patients for gastrectomy, a total of 24 patients underwent CLE assessment, of whom 9 with indefinite lateral margins underwent at least two consecutive CLE follow-ups. A total of 19 lesions were regarded as complete remission, and 5 lesions (21.7%) were incompletely excised according to final pathologic diagnosis. Accuracy of CLE in predicting incomplete resection for original lesions was 91.7%, with sensitivity and specificity of 100.0 and 89.5%, respectively. The residual lesions were treated by additional EMR guided by CLE. There was no recurrence on endoscopic biopsies at mean (range) follow-up of 8.3 (4–15) months.

Conclusions

Confocal laser endomicroscopy has high accuracy for prediction of remnant tissue after EMR, and may lead to significant improvements in clinical surveillance after endoscopic resection.

Keywords

Endoscopic mucosal resection Confocal laser endomicroscopy Neoplasia 

Notes

Acknowledgments

This study was funded by the Clinical Projects Program of the Ministry of Health of China (2007) and the Taishan Scholar Program of Shandong Province.

Disclosures

Authors Rui Ji, Xiu-Li Zuo, Chang-Qing Li, Cheng-Jun Zhou, and Yan-Qing Li have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Rui Ji
    • 1
  • Xiu-Li Zuo
    • 1
  • Chang-Qing Li
    • 1
  • Cheng-Jun Zhou
    • 2
  • Yan-Qing Li
    • 1
  1. 1.Department of GastroenterologyShandong University Qilu HospitalJinanChina
  2. 2.Department of Pathology, The Second Affiliated HospitalShandong UniversityJinanChina

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