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Gastrointest Endosc. 2011 Sep;74(3):465-72. doi: 10.1016/j.gie.2011.04.004. Epub 2011 Jul 13.

Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial.

Author information

1
Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA. psharma@kumc.edu

Abstract

BACKGROUND:

Probe-based confocal laser endomicroscopy (pCLE) allows real-time detection of neoplastic Barrett's esophagus (BE) tissue. However, the accuracy of pCLE in real time has not yet been extensively evaluated.

OBJECTIVE:

To compare the sensitivity and specificity of pCLE in addition to high-definition white-light endoscopy (HD-WLE) with HD-WLE alone for the detection of high-grade dysplasia (HGD) and early carcinoma (EC) in BE.

DESIGN:

International, prospective, multicenter, randomized, controlled trial.

SETTING:

Five tertiary referral centers.

PATIENTS:

A total of 101 consecutive BE patients presenting for surveillance or endoscopic treatment of HGD/EC.

INTERVENTIONS:

All patients were examined by HD-WLE, narrow-band imaging (NBI), and pCLE, and the findings were recorded before biopsy samples were obtained. The order of HD-WLE and NBI was randomized and performed by 2 independent, blinded endoscopists. All suspicious lesions on HD-WLE or NBI and 4-quadrant random locations were documented. These locations were examined by pCLE, and a presumptive diagnosis of benign or neoplastic (HGD/EC) tissue was made in real time. Finally, biopsies were taken from all locations and were reviewed by a central pathologist, blinded to endoscopic and pCLE data.

MAIN OUTCOME MEASUREMENTS:

Diagnostic characteristics of pCLE.

RESULTS:

The sensitivity and specificity for HD-WLE were 34.2% and 92.7%, respectively, compared with 68.3% and 87.8%, respectively, for HD-WLE or pCLE (P = .002 and P < .001, respectively). The sensitivity and specificity for HD-WLE or NBI were 45.0% and 88.2%, respectively, compared with 75.8% and 84.2%, respectively, for HD-WLE, NBI, or pCLE (P = .01 and P = .02, respectively). Use of pCLE in conjunction with HD-WLE and NBI enabled the identification of 2 and 1 additional HGD/EC patients compared with HD-WLE and HD-WLE or NBI, respectively, resulting in detection of all HGD/EC patients, although not statistically significant.

LIMITATIONS:

Academic centers with enriched population.

CONCLUSIONS:

pCLE combined with HD-WLE significantly improved the ability to detect neoplasia in BE patients compared with HD-WLE. This may allow better informed decisions to be made for the management and subsequent treatment of BE patients. (

CLINICAL TRIAL REGISTRATION NUMBER:

NCT00795184.).

PMID:
21741642
PMCID:
PMC3629729
DOI:
10.1016/j.gie.2011.04.004
[Indexed for MEDLINE]
Free PMC Article

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