Probe-Based Confocal Laser Endomicroscopy to Guide Real-Time Endoscopic Therapy in Barrett's Esophagus with Dysplasia
| Autor: | Deepak V. Gopal, Rashmi Agni, Eric A. Johnson, Ryan De Lee, Patrick R. Pfau, Mark Reichelderfer |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Radiofrequency ablation Endoscopic mucosal resection Gastrointestinal epithelium law.invention Barrett's esophagus Endomicroscopy law High-grade dysplasia medicine Barrett’s esophagus Low-grade dysplasia Esophagus lcsh:RC799-869 Published: May 2012 medicine.diagnostic_test business.industry Gastroenterology medicine.disease Surgery Endoscopy medicine.anatomical_structure surgical procedures operative Dysplasia lcsh:Diseases of the digestive system. Gastroenterology Radiology business Probe-based confocal laser |
| Zdroj: | Case Reports in Gastroenterology Case Reports in Gastroenterology, Vol 6, Iss 2, Pp 285-292 (2012) |
| ISSN: | 1662-0631 |
| Popis: | Probe-based confocal laser endomicroscopy (pCLE) is a novel imaging technique which utilizes a low-power laser light passed through a fiber-optic bundle, within a miniprobe that is advanced into the working channel, to obtain microscopic images of the mucosa. This allows the endoscopist to evaluate the microarchitecture of the gastrointestinal epithelium in real time. At this time pCLE cannot replace histopathology, but it can provide diagnostic information as well as guide therapeutic management in patients with Barrett’s esophagus (BE) with high-grade dysplasia (HGD). We describe a retrospective case series in which four patients with BE and biopsy-proven HGD underwent endoscopy with pCLE to direct real-time endoscopic ablation therapy and/or endoscopic mucosal resection (EMR), which was performed in conjunction with pCLE. All four patients had pCLE showing features of HGD. After either EMR or radiofrequency ablation (RFA), pCLE was again used to evaluate the margins after therapy to assure accuracy. In one case, pCLE had features of dysplasia at the margin and further repeat EMR was immediately performed. Another case had a normal-appearing esophagus, but pCLE found features of BE in discrete areas and targeted biopsies were performed, which confirmed BE. This patient subsequently underwent RFA therapy of the residual areas of BE. In conclusion, in patients with BE and dysplasia, pCLE is an effective tool used to target biopsies, guide endoscopic therapy and assess the accuracy of EMR or RFA. |
| Databáze: | OpenAIRE |
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