scholarly journals A Review on the Use of Confocal Laser Endomicroscopy in the Bile Duct

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ioana Smith ◽  
Pamela E. Kline ◽  
Monica Gaidhane ◽  
Michel Kahaleh
Keyword(s):  
Bile Duct ◽  
Tertiary Care ◽  
Biliary Tree ◽  
Multicenter Trial ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Confocal Endomicroscopy ◽  
Pubmed Search

Background. Current methods to diagnose malignant biliary strictures are of low sensitivity. Probe-based confocal laser endomicroscopy (pCLE) is a new approach that can be used to evaluate in vivo histopathology of the GI tract. This paper is of studies evidencing pCLE’s application in the diagnosis of indeterminate biliary strictures.Methods. This paper examined peer-reviewed studies conducted between January 2000 and November 2011. A PubMed search for relevant articles was performed using the following keywords:“pCLE”, “confocal”, “endomicroscopy”, “probe-based confocal laser endomicroscopy”, “and “bile duct”. Further individual review was done to assess the screened articles’ relevance to the topic.Results. After individual review, 6 studies were included; with a cumulative sample size of 165, with 75 subjects identified as having a malignancy. These studies included tertiary care centers in Germany, France, and USA, including one multicenter trial. 3 studies assessed pCLE’s specificity (range 67%–88%) ,sensitivity (range 83%–98), and accuracy (range 81%–86%).Conclusion. Confocal endomicroscopy is a novel and promising modality for the biliary tree. Further studies need to be conducted both to establish its usefulness for the diagnosis of indeterminate biliary strictures and to understand the histological meaning of the imaging patterns that are observed.

S1426: High-Definition In-Vivo Probe-Based Confocal Laser Endomicroscopy of the Common Bile Duct

2010 ◽  
Vol 71 (5) ◽  
pp. AB158-AB159 ◽  
Author(s):  
Frederick K. Shieh ◽  
Michael H. Nathanson ◽  
Hillary Drumm ◽  
Priya A. Jamidar
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
High Definition ◽  
The Common

scholarly journals Emerging Technologies for the Diagnosis of Perihilar Cholangiocarcinoma

2018 ◽  
Vol 38 (02) ◽  
pp. 160-169 ◽  
Author(s):  
Sumera Rizvi ◽  
John Eaton ◽  
Ju Dong Yang ◽  
Vinay Chandrasekhara ◽  
Gregory Gores
Keyword(s):  
Emerging Technologies ◽  
High Specificity ◽  
Biliary Tree ◽  
Extracellular Vesicle ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Conventional Cytology ◽  
Special Expertise

AbstractThe diagnosis of malignant biliary strictures remains problematic, especially in the perihilar region and in primary sclerosing cholangitis (PSC). Conventional cytology obtained during endoscopic retrograde cholangiography (ERC)-guided brushings of biliary strictures is suboptimal due to limited sensitivity, albeit it remains the gold standard with a high specificity. Emerging technologies are being developed and validated to address this pressing unmet patient need. Such technologies include enhanced visualization of the biliary tree by cholangioscopy, intraductal ultrasound, and confocal laser endomicroscopy. Conventional cytology can be aided by employing complementary and advanced cytologic techniques such as fluorescent in situ hybridization (FISH), and this technique should be widely adapted. Interrogation of bile and serum by examining extracellular vesicle number and cargo, and exploiting next-generation sequencing and proteomic technologies, is also being explored. Examination of circulating cell-free deoxyribonucleic acid (cfDNA) for differentially methylated regions is a promising test which is being rigorously validated. The special expertise required for these analyses has to date hampered their validation and adaptation. Herein, we will review these emerging technologies to inform the reader of the progress made and encourage further studies, as well as adaptation of validated approaches.

Use of probe-based confocal laser endomicroscopy (pCLE) in the diagnosis of cholangiocarcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 281-281 ◽  
Author(s):  
John D. Wysocki ◽  
Celeste Newby ◽  
Virendra Joshi
Keyword(s):  
Clinical Presentation ◽  
New Technology ◽  
Needle Aspiration ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Current Sampling ◽  
Diagnostic Modalities ◽  
Repeat Procedures

281 Background: Despite technologic advances in endoscopy and new cytologic techniques, cholangiocarcinoma is a challenging diagnosis for the endoscopist and oncologists. Current sampling techniques include cytology brushing, biopsy, and fine needle aspiration but are limited in their sensitivity. Confocal laser endomicroscopy (CLE) is a relatively new modality that offers in-vivo imaging of the gastrointestinal tract with microscopic detail in living cells. Methods: This was an observational study of 10 patients with indeterminate biliary strictures who were evaluated with ERCP, cholangioscopy, and CLE to determine the sensitivity and specificity of tissue biopsy compared to virtual biopsy using this new technology, CLE. All cases were confirmed to be cholangiocarcinoma by histopathology. Fluorescein 10% was used as a contrast agent. Results: The 10 ERCP cases that were reviewed demonstrated biliary strictures that were suspicious for malignancy based on history and clinical presentation. Nearly all initial brushings and traditional biopsies were inconclusive. Subsequent ERCP and cholangioscopy with CLE imaging was performed. The biliary architecture was concerning for malignancy according to the Miami Criteria. Images were reviewed by 2 independent physicians. Every case demonstrated thick bands >20 µm and dark clumps of glands. Bright vessels ( >20 µm) with tortuosity were visualized in seven cases. Other findings include reticular networks of dark bands and small, fine branching bands <20 µm, but these patterns were infrequent. Conclusions: 1.CLE is a novel tool to investigate indeterminate biliary strictures and potentially diagnose cholangiocarcinoma in conjunction with other diagnostic modalities during the initial ERCP and cholangioscopy. 2. Our early experience found sensitivity 90% , specificity of 100% , NPV 90% 3. CLE gives the opportunity to obtain en-vivo targeted biopsies during cholangioscopy as well as reduce repeat procedures and cost.

scholarly journals Confocal laser endomicroscopy in the diagnosis of extrahepatic bile duct diseases

2019 ◽  
Vol 24 (1) ◽  
pp. 11-16
Author(s):  
E. N. Solodinina ◽  
N. V. Fomicheva ◽  
D. N. Ulyanov
Keyword(s):  
Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Targeted Biopsy ◽  
Bile Duct Diseases ◽  
Edematous Pancreatitis ◽  
Sensitivity Specificity

Aim. To evaluate information content of confocal laser endomicroscopy with targeted biopsy in verifying etiology of extrahepatic bile duct strictures.Material and methods. There were 28 patients with extrahepatic bile duct strictures who underwent retrograde intervention with confocal laser endomicroscopy and targeted biopsy. Data of confocal laser endomicroscopy and biopsy were compared with final postoperative and histological diagnosis. Follow-up within 1–4 years after endoscopic treatment was also considered.Results. Diagnostic sensitivity, specificity and overall accuracy of the method in differential diagnosis of common bile duct strictures were 91.7%, 93.7% and 92.8%, respectively. Complication (acute edematous pancreatitis) occurred in 1 (3.6%) case.Conclusion. Confocal laser endomicroscopy is new effective method for in vivo microscopic assessment of mucous membrane. Despite technical complexity, the method is not associated with advanced morbidity and, accordingly, has no additional contraindications in comparison with ERCP.

Visualization of brain microvasculature and blood flow in vivo: Feasibility study using confocal laser endomicroscopy

2021 ◽  
Author(s):  
Evgenii Belykh ◽  
Xiaochun Zhao ◽  
Brandon Ngo ◽  
Dara S. Farhadi ◽  
Adam Kindelin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Feasibility Study ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Brain Microvasculature

scholarly journals Probe-Based Confocal Laser Endomicroscopy for Indeterminate Biliary Strictures: Refinement of the Image Interpretation Classification

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Michel Kahaleh ◽  
Marc Giovannini ◽  
Priya Jamidar ◽  
S. Ian Gan ◽  
Paola Cesaro ◽  
...  
Keyword(s):  
Prospective Study ◽  
Interobserver Agreement ◽  
Image Interpretation ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Biliary Strictures ◽  
Inflammatory Conditions ◽  
Paris Classification ◽  
Low Sensitivity ◽  
Duct Stricture

Background. Accurate diagnosis and clinical management of indeterminate biliary strictures are often a challenge. Tissue confirmation modalities during Endoscopic Retrograde Cholangiopancreatography (ERCP) suffer from low sensitivity and poor diagnostic accuracy. Probe-based confocal laser endomicroscopy (pCLE) has been shown to be sensitive for malignant strictures characterization (98%) but lacks specificity (67%) due to inflammatory conditions inducing false positives.Methods. Six pCLE experts validated the Paris Classification, designed for diagnosing inflammatory biliary strictures, using a set of 40 pCLE sequences obtained during the prospective registry (19 inflammatory, 6 benign, and 15 malignant). The 4 criteria used included (1) multiple thin white bands, (2) dark granular pattern with scales, (3) increased space between scales, and (4) thickened reticular structures. Interobserver agreement was further calculated on a separate set of 18 pCLE sequences.Results. Overall accuracy was 82.5% (n=40retrospectively diagnosed) versus 81% (n=89prospectively collected) for the registry, resulting in a sensitivity of 81.2% (versus 98% for the prospective study) and a specificity of 83.3% (versus 67% for the prospective study). The corresponding interobserver agreement for 18 pCLE clips was fair (k=0.37).Conclusion. Specificity of pCLE using the Paris Classification for the characterization of indeterminate bile duct stricture was increased, without impacting the overall accuracy.

scholarly journals Endomicroscopy and Cancer: A New Approach to the Visualization of Neoangiogenesis

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Renato Cannizzaro ◽  
Maurizio Mongiat ◽  
Vincenzo Canzonieri ◽  
Mara Fornasarig ◽  
Stefania Maiero ◽  
...  
Keyword(s):  
Cancer Progression ◽  
Confocal Laser Endomicroscopy ◽  
Molecular Profile ◽  
Confocal Laser ◽  
Antiangiogenic Treatment ◽  
New Approach ◽  
Angiogenic Therapy ◽  
Imaging Tool ◽  
Subcellular Resolution

Probe-based Confocal Laser Endomicroscopy (pCLE) is a novel imaging technique for gastrointestinal endoscopy providingin vivomicroscopy at subcellular resolution. It offers the possibility to analyze neoangiogenesis and vessel densityin vivo. Angiogenetic switch is essential in cancer progression. Aim of the paper was to review the use of this imaging tool to analyze colorectal and gastric cancers vascularizationin vivo. The aim is to provide the possibility of combining diagnostic evidences with vascularization and molecular profile to evaluate the efficacy of an antiangiogenic treatment in association with conventional therapy. pCLE can be considered a revolutionary method for real-time assessment of changes in vascularization pattern in this tumors and it may open the possibility to address the use of anti-angiogenic therapy in order to improve the outcome of the treatment.

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