PS02.062: CONFOCAL LASER ENDOMICROSCOPY IN THE ASSESSMENT OF PERSISTENT/RECURRENT INTESTINAL METAPLASIA/NEOPLASIA AFTER ENDOSCOPIC TREATMENT OF BORN

Abstract Background Patients after endoscopic treatment of Barrett's esophagus related neoplasia (BORN) should undergo regular endoscopic surveillance with biopsies to detect recurrent intestinal metaplasia (IM) or neoplasia (N). Probe-based confocal laser endomicroscopy (pCLE) offers detailed examination of cellular structures and may examine larger areas compared to standard biopsy. Methods A single center, prospective, controlled and pathologist-blinded (still ongoing) study in patients undergoing surveillance endoscopy after endoscopic treatment of BORN. pCLE images were obtained from the neo-Z-line (in few cases including macroscopically visible tongues), the cardia and the esophagus. Thereafter, standard biopsies were taken and sent for histopathological analysis (minimally 4 biopsies from macroscopically normal neo-Z-line, 2 biopsies from the cardia and the esophagus and targeted biopsies from visible abnormalities, if present). Results We examined 34 patients, from these 14 patients (41%) had the initial diagnosis of low-grade intraepithelial neoplasia (LGIN), 8 patients (24%) had high-grade intraepithelial neoplasia (HGIN) and 12 patients (35%) had an early adenocarcinoma (EAC). Three patients (9%) underwent endoscopic resection (ER), in 18 patients (53%) we performed ER or dissection of all visible lesions followed by radiofrequency ablation (RFA), and 13 patients (38%) had RFA as a single treatment modality. Persistent/recurrent IM was detected only at the level of neo-Z-line in 8 patients (24%, 8/34 pts) by both methods. pCLE but not biopsies detected persistent/recurrent IM in 2 patients (6%, 2/34), another 2 patients had IM present in biopsies but not in pCLE. pCLE diagnosed one patient with recurrent LGIN in a macroscopic visible tongue arising from neo-Z-line, which was not confirmed in biopsies (there was only agreement in persistent IM detected by both methods). Sensitivity and specificity of pCLE in detection of persistent/recurrent IM was 80% (95% CI 44–98) and 92% (95% CI 73–99), respectively, with a positive predictive value of 80% (95% CI 51–94) and a negative predictive value of 92% (95% CI 76–98). Agreement of pCLE and histopathological findings was 88%. Conclusion pCLE seems comparable to standard biopsies in detection of persistent/recurrent IM after endoscopic treatment of BORN. Nevertheless, these results need to be confirmed in a larger cohort of patients. Disclosure All authors have declared no conflicts of interest.

Download Full-text

Confocal Laser Endomicroscopy vs Biopsies in the Assessment of Persistent or Recurrent Intestinal Metaplasia/Neoplasia after Endoscopic Treatment of Barrett’s Esophagus related Neoplasia

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-2467 ◽

2020 ◽

Vol 29 (3) ◽

pp. 305-312

Author(s):

Jana Krajciova ◽

Marek Kollar ◽

Jana Maluskova ◽

Martin Janicko ◽

Zuzana Vackova ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Low Grade ◽

Predictive Values ◽

Early Adenocarcinoma ◽

Sensitivity Specificity

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.

Download Full-text

Diagnosis of Superficial Gastric Lesions Together with Six Gastric Lymphoma Cases via Probe-Based Confocal Laser Endomicroscopy: A Retrospective Observational Study

Gastroenterology Research and Practice ◽

10.1155/2018/5073182 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Qian Chen ◽

Heng-Hui Cheng ◽

Shuang Deng ◽

Dong Kuang ◽

Chang Shu ◽

...

Keyword(s):

Predictive Value ◽

Gastric Lymphoma ◽

Intraepithelial Neoplasia ◽

Final Diagnosis ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Gastric Lesions ◽

Gi Tract ◽

Diagnostic Ability ◽

White Light Endoscopy

Objective. To evaluate the performance of probe-based confocal laser endomicroscopy (pCLE) in diagnosis of gastric lesions.Methods. An outpatient department- (OPD-) based retrospective study was conducted for patients with suspected upper gastrointestinal (GI) tract lesions who underwent pCLE between 2014 and 2016 at a tertiary hospital in China. Final diagnosis was based on the histopathological reports. CLE reports were compared to histopathological reports to evaluate the diagnostic ability, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.Results. 322 of 380 patients were diagnosed with gastric lesions via pCLE, including inflammation and benign ulcers (n=110), atrophy and intestinal metaplasia (n=152), intraepithelial neoplasia (n=27), adenocarcinoma (n=27), and lymphoma (n=6). In total, the diagnostic ability of CLE in evaluation of gastric lesions showed sensitivity 72.4% (95% confidence interval (CI): 67.1–77.2%); specificity 93.1% (95% CI: 5.6–8.4%); PPV 72.4% (95% CI: 67.1–77.2%); NPV 93.1% (95% CI: 5.6–8.4%); and accuracy 88.9% (95% CI: 87.3–90.4%), respectively. We further observed the capability of pCLE in diagnosing six gastric lymphoma showing those affected mucosa densely infiltrated with identical and round-shaped abnormal cells. Immunohistochemistry analysis confirmed one patient with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL) and five with mucosa-associated lymphoid tissue (MALT) lymphoma.Conclusion. pCLE is an accurate tool for the detection of gastric lesions and shows optimal values of sensitivity and negative predictivity. Moreover, combining pCLE with white light endoscopy (WLE) may be a promising adjunct to conventional biopsy sampling in evaluating GI tract with suspected lymphoma.

Download Full-text

Su1998 - Confocal Laser Endomicroscopy in the Assessment of Persistent or Recurrent Intestinal Metaplasia/Neoplasia after Endoscopic Treatment of Barrett's Esophagus Related Neoplasia

Gastroenterology ◽

10.1016/s0016-5085(18)32342-4 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-660

Author(s):

Jana Krajciova ◽

Marek Kollar ◽

Jana Maluskova ◽

Martin Kment ◽

Zuzana Vackova ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser

Download Full-text

Confocal laser endomicroscopy under propofol‐based sedation for early gastric cancer and pre‐cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China

BMC Anesthesiology ◽

10.1186/s12871-021-01312-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lihua Chu ◽

Jialian Zhao ◽

Cheng Sheng ◽

Min Yue ◽

Feifei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Intestinal Metaplasia ◽

Retrospective Cohort ◽

Precancerous Lesions ◽

Characteristic Curve ◽

Intraepithelial Neoplasia ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Patient Cooperation

Abstract Background Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions. Methods A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n = 126) and the un-sedated group (n = 100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines. Results The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95 % CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95 % CI: 0.80 to 0.97), P = 0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P = 0.0008 and P = 0.0001, respectively). For patients considered as high-grade intraepithelial neoplasia or EGC by endoscopists, they would not get biopsy during CLE but receive endoscopic submucosal dissection (ESD) subsequently, and the misdiagnosis rate of CLE was 0 % in the sedated group and 27.59 % (95 % CI: 10.30–44.91 %) in the un-sedated group (P = 0.006). Conclusions Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).

Download Full-text

CONFOCAL LASER ENDOMICROSCOPY IN THE ASSESSMENT OF PERSISTENT OR RECURRENT INTESTINAL METAPLASIA/NEOPLASIA AFTER ENDOSCOPIC TREATMENT OF BARRETT'S ESOPHAGUS RELATED NEOPLASIA – A PROSPECTIVE STUDY

10.1055/s-0039-1681832 ◽

2019 ◽

Author(s):

J Krajciova ◽

M Kollar ◽

J Maluskova ◽

M Kment ◽

Z Vackova ◽

...

Keyword(s):

Prospective Study ◽

Intestinal Metaplasia ◽

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

A Prospective Study

Download Full-text

A prospective, single-center, cross-over controlled trial of confocal laser endomicroscopy assessment of persistent or recurrent intestinal metaplasia and recurrence of neoplasia after endoscopic treatment of Barrett's esophagus related neoplasia (BORN)

10.26226/morressier.59a6b34ad462b80290b55647 ◽

2017 ◽

Author(s):

Jana Krajciova

Keyword(s):

Intestinal Metaplasia ◽

Barrett’S Esophagus ◽

Endoscopic Treatment ◽

Barrett's Esophagus ◽

Controlled Trial ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Single Center

Download Full-text

Confocal laser endomicroscopy under propofol-based sedation for early gastric cancer and pre-cancerous lesions is associated with better diagnostic accuracy: a retrospective cohort study in China

10.21203/rs.3.rs-41225/v3 ◽

2020 ◽

Author(s):

Lihua Chu ◽

Jialian Zhao ◽

Cheng Sheng ◽

Min Yue ◽

Feifei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Intestinal Metaplasia ◽

Retrospective Cohort ◽

Precancerous Lesions ◽

Characteristic Curve ◽

Intraepithelial Neoplasia ◽

Confocal Laser Endomicroscopy ◽

Confocal Laser ◽

Patient Cooperation

Abstract Background: Confocal laser endomicroscopy (CLE) has advantages in detecting gastric neoplastic lesions, meanwhile it requires strict patient cooperation. Sedation could improve patient cooperation and quality of endoscopy. However, sedation is still not very popular in some resource-limited countries and regions. The purpose of this study was to compare propofol-based sedated versus un-sedated CLE in the value of diagnosing early gastric cancer (EGC) and precancerous lesions.Methods: A retrospective, cohort, single center study of 226 patients who underwent CLE between January 1, 2015 and December 31, 2017 was performed. Patients enrolled were allocated into the propofol-based sedated group (n=126) and the un-sedated group (n=100). The comparison of validity and reliability of CLE for identifying EGC and precancerous lesions between the two groups was performed through analyzing CLE diagnosis and pathological diagnosis. Reporting followed the STROBE guidelines.Results: The area under receiver operating characteristic curve (AUROC) of diagnosing EGC in the sedated group was 0.97 (95% CI: 0.95 to 0.99), which was higher than that in the un-sedated group (0.88 (95% CI: 0.80 to 0.97), P =0.0407). CLE with sedation performed better than without sedation in diagnosing intraepithelial neoplasia and intestinal metaplasia (P =0.0008 and P =0.0001, respectively). Conclusion: Propofol based sedation was associated with improved diagnostic value of CLE for detecting EGC as well as precancerous lesions (intraepithelial neoplasia OR intestinal metaplasia).

Download Full-text

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.

Download Full-text