Su1997 - Generation and Validation of New Confocal Laser Endomicroscopy Criteria for the Diagnosis of Low-Grade Dysplasia in Barrett's Esophagus

Background and Aims: Patients after endoscopic treatment of Barrett‘s esophagus (BE) related neoplasia (BORN) should enter endoscopic surveillance with biopsies to detect persistent or recurrent neoplasia or intestinal metaplasia (IM). Probe-based confocal laser endomicroscopy (pCLE) serves as a virtual biopsy and could replace standard biopsies. However, the role of pCLE in patients after endoscopic treatment of BORN has not been systematically assessed. The aim of this study was to compare pCLE with biopsies in detecting persistent/recurrent IM/neoplasia. Methods: A single center, prospective and pathologist-blinded study was performed. Patients after endoscopic treatment of BORN (endoscopic resection or dissection, radiofrequency ablation) underwent surveillance endoscopy with pCLE followed by biopsies. Results: A total of 56 patients were enrolled: initial diagnoses were low-grade dysplasia (LGD) in 24 patients (43%), high-grade dysplasia (HGD) in 12 patients (21%) and early adenocarcinoma (EAC) in 20 patients (36%). Only one patient (2%) experienced recurrent neoplasia (LGD), which was diagnosed by pCLE only. Twenty patients (35.7%) experienced persistent/recurrent IM, diagnosed by both pCLE and biopsies in 17 patients (17/30, 85%) and by pCLE only in 3 pts (3/30, 15%). Sensitivity, specificity, positive and negative predictive values to diagnose recurrent/persistent IM did not differ significantly between pCLE and biopsies; diagnostic accuracy was 100% (95%CI 93.6-100) for pCLE and 94.6 (95%CI 85.1-98.9%) for biopsies, p=0.25. In patients with IM detected by both tested methods, pCLE detected significantly more goblet cells (median 43 per patient) than biopsies (median 12 per patient), p=0.01. Conclusion: pCLE is at least as effective as standard biopsies in the detection of persistent/recurrent IM after endoscopic treatment of BORN.

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Accuracy of probe-based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett’s esophagus

Endoscopy International Open ◽

10.1055/s-0043-124868 ◽

2018 ◽

Vol 06 (04) ◽

pp. E414-E420 ◽

Cited By ~ 9

Author(s):

Tilak Shah ◽

Robert Lippman ◽

Divyanshoo Kohli ◽

Pritesh Mutha ◽

Sanjeev Solomon ◽

...

Keyword(s):

Real Time ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Eradication Therapy ◽

Observer Agreement ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Lower Sensitivity ◽

Low Grade ◽

Esophageal Mucosa

Abstract Background For surveillance of Barrett’s esophagus (BE), the current standard of random 4-quadrant biopsies misses 10 – 50 % of esophageal neoplasms, and does not permit real-time decision-making. Probe-based confocal laser endomicroscopy (pCLE) permits real-time in vivo histologic assessment of esophageal mucosa during upper endoscopy. Prospective studies comparing the accuracy of pCLE to 4-quadrant biopsies in routine clinical practice are lacking. Methods Consecutive patients with BE underwent high definition white light and narrow-band imaging followed by pCLE and targeted biopsy or mucosal resection. Four-quadrant biopsies were obtained during the same session. Baseline variables, real-time pCLE interpretation, and histology results were prospectively recorded. Blinded expert review of pCLE sequences and histology specimens was performed. A sample size of 64 patients was calculated a priori based on 3 % estimated prevalence of high grade dysplasia (HGD) or cancer. Results In total, 66 patients were included in the study. The prevalence of HGD or cancer was 4.55 %. Both real-time and blinded pCLE correctly identified all cases of cancer. For the primary outcome, real-time pCLE was 98 % specific but only 67 % sensitive for HGD/cancer compared to non-blinded pathologist interpretation. For HGD and cancer, inter-observer agreement was substantial between real-time and blinded endomicroscopists (kappa = 0.6). pCLE identified dysplasia in 75 % of cases where both blinded and unblinded pathology interpretation was low grade dysplasia. Conclusions pCLE demonstrates high specificity for detecting dysplasia and cancer, but lower sensitivity may limit its utility in routine BE surveillance. pCLE may have a role in confirming LGD in real-time before eradication therapy.

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CONFOCAL LASER ENDOMICROSCOPY IN DIAGNOSING GASTRIC AND ESOPHAGEAL LESIONS AND IN POST-RFA SURVEILLANCE OF PATIENTS WITH BARRETT'S ESOPHAGUS

10.1055/s-0038-1637429 ◽

2018 ◽

Author(s):

J Krajciova ◽

M Kollar ◽

J Maluskova ◽

Z Vackova ◽

J Spicak ◽

...

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser

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LOW-GRADE DYSPLASIA IN BARRETT’S ESOPHAGUS IS DOWNGRADED IN HALF OF THE CASES AFTER SYSTEMATIC EXPERT PATHOLOGY REVIEW BEFORE PATIENT REFERRAL FOR ENDOSCOPIC TREATMENT

10.1055/s-0040-1704296 ◽

2020 ◽

Author(s):

P Leclercq ◽

G De Hertogh ◽

R Bisschops

Keyword(s):

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Low Grade ◽

Patient Referral ◽

Low Grade Dysplasia ◽

Pathology Review

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Faculty Opinions recommendation of A Barrett's esophagus registry of over 1000 patients from a specialist center highlights greater risk of progression than population-based registries and high risk of low grade dysplasia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726057371.793512957 ◽

2016 ◽

Author(s):

Pradeep Bhandari

Keyword(s):

High Risk ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Population Based ◽

Low Grade ◽

Risk Of Progression ◽

Low Grade Dysplasia ◽

Specialist Center

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Faculty Opinions recommendation of Patients With Barrett's Esophagus and Confirmed Persistent Low-Grade Dysplasia Are at Increased Risk for Progression to Neoplasia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727144253.793531100 ◽

2017 ◽

Author(s):

Pradeep Bhandari ◽

Gaius Longcroft-Wheaton

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Low Grade ◽

Increased Risk ◽

Low Grade Dysplasia

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Probe-based confocal laser endomicroscopy and Barrett's esophagus – just a scientific toy or significant improvement in diagnosis?

Digestive Diseases ◽

10.1159/000516257 ◽

2021 ◽

Author(s):

Luka Vranić ◽

Tin Nadarević ◽

Davor Štimac

Keyword(s):

Diagnostic Accuracy ◽

Real Time ◽

Barrett’S Esophagus ◽

Predictive Value ◽

Barrett's Esophagus ◽

High Reliability ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Imaging Method ◽

Increased Risk

Background: Barrett’s esophagus (BE) requires surveillance to identify potential neoplasia at early stage. Standard surveillance regimen includes random four-quadrant biopsies by Seattle protocol. Main limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations. Summary: pCLE represents real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patient. The main advantages would be real-time diagnosis and decision making, greater diagnostic accuracy and to evaluate larger area compared to random biopsies. Clinical pCLE studies in esophagus show high diagnostic accuracy and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key messages: Despite promising results, its role in routine use in patients with Barrett’s esophagus remains questionable primarily due to lack of well-organized double-blind randomized trials.

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