Digestive Diseases and Sciences

, Volume 58, Issue 1, pp 188–193 | Cite as

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

  • Helga Bertani
  • Marzio Frazzoni
  • Emanuele Dabizzi
  • Flavia Pigò
  • Luisa Losi
  • Mauro Manno
  • Raffaele Manta
  • Gabrio Bassotti
  • Rita Conigliaro
Original Article

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 

References

  1. 1.
    Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008;103:788–797.PubMedCrossRefGoogle Scholar
  2. 2.
    Prasad GA, Bansal A, Sharma P, et al. Predictors of progression in Barrett’s esophagus: current knowledge and future directions. Am J Gastroenterol. 2010;105:1490–1502.PubMedCrossRefGoogle Scholar
  3. 3.
    American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011;140:1084–1091.Google Scholar
  4. 4.
    Boyer J, Laugier R, Chemali M, et al. French Society of Digestive Endoscopy guideline: monitoring of patients with Barrett’s esophagus. Endoscopy. 2007;39:840–842.PubMedCrossRefGoogle Scholar
  5. 5.
    Harrison R, Perry I, Haddadin W, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol. 2007;102:1154–1161.PubMedCrossRefGoogle Scholar
  6. 6.
    Abela JE, Going JJ, Mackenzie JF, et al. Systematic four-quadrant biopsy detects Barrett’s dysplasia in more patients than nonsystematic biopsy. Am J Gastroenterol. 2008;103:850–855.PubMedCrossRefGoogle Scholar
  7. 7.
    Kariv R, Plesec TP, Goldblum JR, et al. The Seattle protocol does not more reliably predict the detection of cancer at the time of esophagectomy than a less intensive surveillance protocol. Clin Gastroenterol Hepatol. 2009;7:653–658.PubMedCrossRefGoogle Scholar
  8. 8.
    Kiesslich R, Gossner L, Goetz M, et al. In vivo histology of Barrett’s esophagus and associated neoplasia by confocal laser endomicroscopy. Clin Gastroenterol Hepatol. 2006;4:979–987.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunbar KB, Okolo P, Montgomery E, Canto MI. Confocal laser endomicroscopy in Barrett’s esophagus and endoscopically inapparent Barrett’s neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointest Endosc. 2009;70:645–654.PubMedCrossRefGoogle Scholar
  10. 10.
    Pohl H, Rosch T, Vieth M, et al. Miniprobe confocal laser microscopy for the detection of invisible neoplasia in patients with Barrett’s esophagus. Gut. 2008;57:1648–1653.PubMedCrossRefGoogle Scholar
  11. 11.
    Wallace MB, Sharma P, Lightdale C, et al. Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett’s esophagus with probe-based confocal laser endomicroscopy. Gastrointest Endosc. 2010;72:19–24.PubMedCrossRefGoogle Scholar
  12. 12.
    Bajbouj M, Vieth M, Rosch T, et al. Probe-based confocal laser endomicroscopy compared with standard four-quadrant biopsy for evaluation of neoplasia in Barrett’s esophagus. Endoscopy. 2010;42:435–440.PubMedCrossRefGoogle Scholar
  13. 13.
    Frazzoni M, Savarino E, Manno M, et al. Reflux patterns in patients with short segment Barrett’s oesophagus: a study using impedance-pH monitoring off and on proton pump inhibitor therapy. Aliment Pharmacol Ther. 2009;30:508–515.PubMedCrossRefGoogle Scholar
  14. 14.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.PubMedCrossRefGoogle Scholar
  15. 15.
    Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–1399.PubMedCrossRefGoogle Scholar
  16. 16.
    Wallace M, Lauwers GY, Chen Y, et al. Miami classification for probe-based confocal laser endomicroscopy. Endoscopy. 2011;43:882–891.PubMedCrossRefGoogle Scholar
  17. 17.
    Haggitt RC. Barrett’s esophagus, dysplasia, and adenocarcinoma. Hum Pathol. 1994;25:982–993.PubMedCrossRefGoogle Scholar
  18. 18.
    Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001;32:368–378.PubMedCrossRefGoogle Scholar
  19. 19.
    Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–e52.PubMedCrossRefGoogle Scholar
  20. 20.
    Sharma P, Meining A, Coron E, et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc. 2011;74:465–472.PubMedCrossRefGoogle Scholar
  21. 21.
    Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–1831.PubMedCrossRefGoogle Scholar
  22. 22.
    Zagari RM, Fuccio L, Wallander M-A, et al. Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: the Loiano–Monghidoro study. Gut. 2008;57:1354–1359.PubMedCrossRefGoogle Scholar
  23. 23.
    Iftikhar SY, James PD, Steele RJ, et al. Length of Barrett’s oesophagus: an important factor in the development of dysplasia and adenocarcinoma. Gut. 1992;33:1155–1158.PubMedCrossRefGoogle Scholar
  24. 24.
    Wolfsen HC, Hemminger LL, Wallace MB, et al. Clinical experience of patients undergoing photodynamic therapy for Barrett’s dysplasia or cancer. Aliment Pharmacol Ther. 2004;20:1125–1131.PubMedCrossRefGoogle Scholar
  25. 25.
    Wani S, Falk JW, Hall M, et al. Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2011;9:220–227.PubMedCrossRefGoogle Scholar
  26. 26.
    Sikkema M, Looman CWN, Steyerberg EW, et al. Predictors for neoplastic progression in patients with Barrett’ s esophagus: a prospective cohort study. Am J Gastroenterol. 2011;106:1231–1238.PubMedCrossRefGoogle Scholar
  27. 27.
    Lim CH, Treanor D, Dixon MF, et al. Low grade dysplasia in Barrett’s esophagus has a high risk of progression. Endoscopy. 2007;39:581–587.PubMedCrossRefGoogle Scholar
  28. 28.
    Curvers WL, Kate FJ, Krishnadath KK, et al. Low-grade dysplasia in Barrett’s esophagus: overdiagnosed and underestimated. Am J Gastroenterol. 2010;105:1523–1530.PubMedCrossRefGoogle Scholar
  29. 29.
    Wani S, Falk JW, Post J, et al. Risk factors for progression of low-grade dysplasia in patients with Barrett’s esophagus. Gastroenterology. 2011;141:1179–1186.PubMedCrossRefGoogle Scholar
  30. 30.
    Hvid-Jensen F, Pedersen L, Mohr Drewes A, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375–1383.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Helga Bertani
    • 1
  • Marzio Frazzoni
    • 2
  • Emanuele Dabizzi
    • 1
  • Flavia Pigò
    • 1
  • Luisa Losi
    • 3
  • Mauro Manno
    • 1
  • Raffaele Manta
    • 1
  • Gabrio Bassotti
    • 4
  • Rita Conigliaro
    • 1
  1. 1.Endoscopia DigestivaNuovo Ospedale S. AgostinoModenaItaly
  2. 2.Fisiopatologia Digestiva Nuovo Ospedale S. AgostinoModenaItaly
  3. 3.Anatomia Patologica Ospedale PoliclinicoModenaItaly
  4. 4.Clinica di Gastroenterologia ed EpatologiaPerugiaItaly

Personalised recommendations