Probe-Based Confocal Laser Endomicroscopy and Barrett’s Esophagus: Just a Scientific Toy or Significant Improvement in Diagnosis?
| Autor: | Tin Nadarević, Davor Štimac, Luka Vranić |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Dysplasia
medicine.medical_specialty Esophageal Neoplasms Biopsy Magnification Barrett Esophagus medicine Humans Barrett’s esophagus In patient Confocal laser endomicroscopy Stage (cooking) Esophagus BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Internal Medicine Early esophageal carcinoma Randomized Controlled Trials as Topic BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Interna medicina Microscopy Confocal medicine.diagnostic_test business.industry Lasers Gastroenterology Reproducibility of Results Sampling error General Medicine medicine.disease medicine.anatomical_structure Barrett's esophagus Esophagoscopy Radiology business |
| Zdroj: | Digestive Diseases Volume 40 Issue 1 |
| ISSN: | 1421-9875 0257-2753 |
| DOI: | 10.1159/000516257 |
| Popis: | Background: Barrett’s esophagus (BE) requires surveillance to identify potential neoplasia at an early stage. The standard surveillance regimen includes random 4-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 a real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1,000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patients. The main advantages would be real-time diagnosis and decision-making, greater diagnostic accuracy, and evaluation of larger area compared to random biopsies. Clinical pCLE studies in the 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 BE remains questionable primarily due to lack of well-organized double-blind randomized trials. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|