Konfokální laserová endomikroskopie v diagnostice onemocnění jícnu: pilotní studie

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Authors: Lumír Kunovský ^1,2; Zdeněk Kala ²; Radek Kroupa ¹; Tomáš Grolich ²; Jiří Dolina ¹; Milan Dastych ¹; Jitka Vaculová ¹; Jakub Vlažný ³; Petr Moravčík ²; Lydie Izakovičová Hollá ^4,5; Petra Bořilová Linhartová ^4,5; Petr Jabandžiev ⁶; Vladimír Prochazka ²
Authors‘ workplace: Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk, University, Brno, Czech Republic ¹; Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic ²; Department of Pathology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic ³; Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic ⁴; Clinic of Stomatology, St. Anne’s Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic ⁵; Department of Pediatrics, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic ⁶
Published in: Vnitř Lék 2020; 66(5): 62-68
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Overview

Úvod: Konfokální laserová endomikroskopie využívající sondy (probe-based confocal laser endomicroscopy – pCLE) je nová diagnostická metoda určená pro endoskopii, která umožňuje mikroskopické vyšetření na buněčné úrovni v reálném čase. Endoskopická diagnostika časných neoplastických lézí distálního jícnu není snadná a často tyto léze mohou být přehlédnuty. Cílem pilotní studie bylo získat charakteristické pCLE obrazy u onemocnění jícnu pro další studie a vyhodnotit možnou roli pCLE v diagnostice dysplastického Barrettova jícnu (Barrett´s esophagus – BE) a časného adenokarcinomu jícnu (esophageal adenocarcinoma – EAC).

Metody: Nejprve byl vyhledán přehled současné literatury s následným nastudováním předchozích publikací obsahující pCLE obrazy a jejich klasifikací u onemocnění jícnu. V druhé fázi byli do této pilotní studie zařazeni pacienti s onemocněním jícnu, kteří podstoupili horní endoskopické vyšetření s pCLE. Zařazena byla i zdravá kohorta osob.

Výsledky: Od ledna roku 2019 do července roku 2019 bylo vyšetřeno celkem 14 pacientů v rámci této prospektivní pilotní studie: 3 pacienti s refluxní ezofagitidou, 4 s BE, 3 s EAC a 4 zdravé osoby. Byla provedena endoskopie s pCLE a získány charakteristické pCLE obrazy. Správná diagnóza byla endoskopistou stanovena pomocí pCLE (real-time) celkem u 11 ze 14 vyšetřených pacientů (78,6 %).

Závěr: Bylo možné získat typické pCLE obrazy u onemocnění jícnu během standardní endoskopie s využitím capu. pCLE se zdá být novou slibnou metodou k surveillance BE a detekci časných neoplastických lézí. Na druhou stranu je zapotřebí více dalších studií a dat na větším souboru pacientů.

Klíčová slova:

Barrettův jícen – ezofagitida – konfokální laserová endomikroskopie – nádory jícnu

Sources

1. Desai TK, Krishnan K, Samala N et al. The incidence of oesophageal adenocarcinoma in non‑dysplastic Barrett’s oesophagus: a meta‑analysis. Gut 2012; 61: 970–976.

2. Dolak W, Mesteri I, Asari R et al. A pilot study of the endomicroscopic assessment of tumor extension in Barrett’s esophagus–associated neoplasia before endoscopic resection. Endosc Int Open 2015; 3: E19–E28.

3. Weusten B, Bisschops R, Coron E et al. Endoscopic management of Barrett’s esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2017; 49: 191–198.

4. Schölvinck DW, van der Meulen K, Bergman JJGHM et al. Detection of lesions in dysplastic Barrett’s esophagus by community and expert endoscopists. Endoscopy 2017; 49: 113–120.

5. Rastogi A, Puli S, El‑Serag HB et al. Incidence of esophageal adenocarcinoma in patients with Barrett’s esophagus and high‑grade dysplasia: a meta‑analysis. Gastrointest Endosc 2008; 67: 394–398.

6. Naini BV, Souza RF, Odze RD Barrett’s Esophagus: A Comprehensive and Contemporary Review for Pathologists. Am J Surg Pathol 2016; 40: e45–e66.

7. Wallace M, Lauwers GY, Chen Y et al. Miami classification for probe‑based confocal laser endomicroscopy. Endoscopy 2011; 43: 882–891.

8. Gaddam S, Mathur SC, Singh M et al. Novel probe‑based confocal laser endomicroscopy criteria and interobserver agreement for the detection of dysplasia in Barrett’s esophagus. Am J Gastroenterol 2011; 106: 1961–1969.

9. di Pietro M, Bertani H, O'Donovan M et al. Development and Validation of Confocal Endomicroscopy Diagnostic Criteria for Low‑Grade Dysplasia in Barrett’s Esophagus. Clin Transl Gastroenterol 2019; 10: e00014.

10. Moravčík P, Hlavsa J, Kunovský L et al. Confocal Laser Endomicroscopy in the Diagnostics of Malignancy of the Gastrointestinal Tract. Klin Onkol 2017; 30: 258–263.

11. Fuks D, Pierangelo A, Validire P et al. Intraoperative confocal laser endomicroscopy for real‑time in vivo tissue characterization during surgical procedures. Surg Endosc 2019; 33: 1544–1552.

12. Sharma P, Meining AR, Coron E et al. 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. Gastrointest Endosc 2011; 74: 465–472.

13. Canto MI, Anandasabapathy S, Brugge W et al. In vivo endomicroscopy improves detection of Barrett’s esophagus‑related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014; 79: 211–221.

14. Shah T, Lippman R, Kohli D et al. Accuracy of probe‑based confocal laser endomicroscopy (pCLE) compared to random biopsies during endoscopic surveillance of Barrett’s esophagus. Endosc Int Open 2018; 6: E414–E420.

15. Kariv R, Plesec TP, Goldblum JR et al. The Seattle protocol does not more reliably predict the detection of cancer at the time of esophagectomy than a less intensive surveillance protocol. Clin Gastroenterol Hepatol 2009; 7: 653–658.

16. Caillol F, Godat S, Poizat F et al. Probe confocal laser endomicroscopy in the therapeutic endoscopic management of Barrett’s dysplasia. Ann Gastroenterol 2017; 30: 295–301.

17. Siegel R, Naishadham D, Jemal A Cancer statistics, 2012 CA Cancer J Clin 2012; 62: 10–29.

18. Hur C, Miller M, Kong CY et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer 2013; 119: 1149–1158.

19. Falk GW Barrett’s Esophagus: Frequency and Prediction of Dysplasia and Cancer. Best Pract Res Clin Gastroenterol 2015; 29: 125–138.

20. Domper Arnal MJ, Ferrández Arenas Á, Lanas Arbeloa Á Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries. World J Gastroenterol 2015; 21: 7933–7943.

21. Svoboda P, Dítě P, Klvaňa P et al. Risk factors and progression predictors of Barrett’s oesophagus to adenocarcinoma. Vnitř Lék 2014; 60: 467–473.

22. Pech O, Gossner L, Manner H et al. Prospective evaluation of the macroscopic types and location of early Barrett’s neoplasia in 380 lesions. Endoscopy 2007; 39: 588–593.

23. Kariyawasam VC, Bourke MJ, Hourigan LF et al. Circumferential location predicts the risk of high‑grade dysplasia and early adenocarcinoma in short‑segment Barrett’s esophagus. Gastrointest Endosc 2012; 75: 938–944.

24. Pohl H, Wrobel K, Bojarski C et al. Risk factors in the development of esophageal adenocarcinoma. Am J Gastroenterol 2013; 108: 200–207.

25. Anaparthy R, Gaddam S, Kanakadandi V et al. Association between length of Barrett’s esophagus and risk of high‑grade dysplasia or adenocarcinoma in patients without dysplasia. Clin Gastroenterol Hepatol 2013; 11: 1430–1436.

26. Richardson C, Colavita P, Dunst C et al. Real‑time diagnosis of Barrett’s esophagus: a prospective, multicenter study comparing confocal laser endomicroscopy with conventional histology for the identification of intestinal metaplasia in new users. Surg Endosc 2019; 33: 1585–1591.

27. Fitzgerald RC, di Pietro M, Ragunath K et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014; 63: 7–42.

28. Shaheen NJ, Sharma P, Overholt BF et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009; 360: 2277–2288.

29. Kroupa R, Konečný Š, Dolina J Current trends in the diagnosis and treatment of gastroesophageal reflux disease. Vnitř Lék 2018; 64: 588–594.

30. Martínek J, Falt P, Gregar J et al. Guidelines of the Czech gastroenterological society -endoscopic treatment of Barrett’s esophagus and early esophageal neoplasia. Gastroent Hepatol 2013; 67: 479–487.

31. Leers JM, DeMeester SR, Oezcelik A et al. The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens. Ann Surg 2011; 253: 271–278.

32. Pimentel‑Nunes P, Dinis‑Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829–854.

33. Lin JL T1 esophageal cancer, request an endoscopic mucosal resection (EMR) for in‑depth review. J Thorac Dis 2013; 5: 353–356.

34. Barbour AP, Jones M, Brown I et al. Risk stratification for early esophageal adenocarcinoma: analysis of lymphatic spread and prognostic factors. Ann Surg Oncol 2010; 17: 2494–2502.

35. Xiong YQ, Ma SJ, Zhou JH et al. A meta‑analysis of confocal laser endomicroscopy for the detection of neoplasia in patients with Barrett’s esophagus. J Gastroenterol Hepatol 2016; 31: 1102–1110.

36. Xiong YQ, Ma SJ, Hu HY et al. Comparison of narrow‑band imaging and confocal laser endomicroscopy for the detection of neoplasia in Barrett’s esophagus: A meta‑analysis. Clin Res Hepatol Gastroenterol 2018; 42: 31–39.

37. Wallace MB, Meining A, Canto MI et al. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharmacol Ther 2010; 31: 548–552.

38. Groof J de, van der Sommen F, van der Putten J et al. The Argos project: The development of a computer‑aided detection system to improve detection of Barrett’s neoplasia on white light endoscopy. United Eur Gastroenterol J 2019; 7: 538–547.