Confocal laser endomicroscopy in the diagnostics of gastrointestinal lesions − literary review and personal experience
Authors:
M. Kollár 1; J. Krajčíová 2; R. Husťak 3,4; J. Malušková 1; M. Kment 1; Z. Vacková 2; J. Špičák 2; J. Martínek 2,3
Authors‘ workplace:
Pracoviště klinické a transplantační patologie, Institut klinické a experimentální medicíny, Praha
1; Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha
2; Interná klinika, Fakultná nemocnica Trnava
3; Katedra laboratórnych vyšetrovacích metód v zdravotníctve, Trnavská univerzita
4
Published in:
Rozhl. Chir., 2018, roč. 97, č. 12, s. 531-538.
Category:
Review
Overview
Introduction:
Confocal laser endomicroscopy (CLE) is a new method enabling real-time histopathological diagnosis. Two platforms of CLE are used standardly: the so called probe-based CLE in which an endomicroscopic probe is inserted through an endoscope, and so-called needle-based CLE inserted through a needle.
Methods:
CLE enables evaluation of epithelial and subepithelial structures with 1000x magnification in any part of the gastrointestinal system. The main advantage over conventional biopsies can be immediate diagnosis and larger area evaluated. CLE might play a promising role in indeterminate biliary lesions where biopsies are often not sufficient and fail to allow for accurate diagnosis. CLE can also have a promising potential in pancreatic lesions where it is used along with the needle designed for tissue aspiration during endosonography. It is also possible to use CLE in other organ systems and medical specialties, e.g. in pneumology, neurosurgery, ENT and others.
Conclusion:
CLE is a promising diagnostic method; however, it is unlikely to replace standard biopsies currently since these are still considered a gold standard of histopathological diagnosis. High purchase price is a main disadvantage of the method, hampering its expansion in medicine.
Key words:
confocal laser endomicroscopy − CLE − biliary strictures − pancreatic lesions − esophageal carcinoma
Rozhl Chir 2018;97:531–538
Sources
- Dunbar BK. Endomicroscopy in Barrett’s esophagus. Gastrointest Endosc Clin N AM 2013;21:565−79.
- Wallace BM, Sharma P, Lightdale C, et al. Preliminary accuracy and interobserver agreement for the detection of intraepithelial neoplasia in Barrett’s esophagus with probe-based confocal laser endomicroscopy. Gastrointest Endosc 2010;72:19−24.
- Kopáčová M, Bureš J, Österreicher J, et al. Konfokální laserová endomikroskopie u experimentálního prasete. Metodika ex vivo zobrazení. Cas Lek Cesk 2009;148:249−53.
- Kopáčová M, Rejchrt S, Tyčová V, et al. Confocal laser scanning endomicroscopy. Initial experience in the Czech Republic. Folia Gastroenterol Hepatol 2007;5:20−31.
- Sharma P, Meining AR, Coron E, et al. Realtime increased detection of neoplastic tissue in Barrett’s esophagus with probebased confocal laser endomicroscopy: Final results of a Multicenter Prospective International Randomized Controlled Trial. Gastrointest Endosc 2011;74:465−72.
- Li WB, Zuo XL, Li CQ, et al. Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions. Gut 2011;60:299−306.
- Guo YT, Li YQ, Yu T, et al. Diagnosis of gastric intestinal metaplasia with confocal laser endomicroscopy in vivo: a prospective study. Endoscopy 2008;40:547−53.
- Lim LG, Yeoh KG, Srivastava S, et al. Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and whitelight endoscopy for diagnosis of gastric intestinal metaplasia. Surg Endosc 2013;27:4649−55.
- Li Z, Zuo XL, Yu T, et al. Confocal laser endomicroscopy for in vivo detection of gastric intestinal metaplasia: a randomized controlled trial. Endoscopy 2014;46:282−90.
- Shadid MW, Buchner AM, Coron E, et al. Diagnostic accuracy of probe based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR: A prospective study. Gastrointest Endosc 2012;75:525−33.
- Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterol 2004; 126:1330−6.
- Jais B, Rebours V, Malleo G, et al. Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2015;65:305−12.
- Konda VJ, Meining A, Jamil LH, et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosconographic guidance. Endoscopy 2013;45:1006−13.
- Nakai Y, Iwashita T, Park DH, et al. Diagnosis of pancreatic cysts: EUS-guided, through the needle confocal laserinduced endomicroscopy and cytoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204−14.
- Napoleon B, Lemaistre Al, Pujol B, et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-needle based confocal laser endomicroscopy. Endoscopy 2015;47:26−32.
- Slivka A, Gan I, Jamidar P, et al. Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study. Gastrointest Endosc 2015;81:282−90.
- Shah RJ, Langer DA, Antillon MR, et al. Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreatobiliary pathology. Clin Gastroenterol Hepatol 2006;4:219−25.
- Gerhards MF, Vos P, van Gulik TM, et al. Incidence of benign lesions in patients resected for suspicious hilar obstruction. Br J Surg 2001;88:48−51.
- Varadarajulu S, Eloubeidi MD. The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. Surg Clin North Am 2010;90:251−63.
- Anderson MA, Appalaneni V, Ben-Menachem T, et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013;77:167−74.
- Meining A, Chen YK, Pleskow D. et al. Direct visualization of indeterminate pancreatobiliary strictures with probe-based confocal laser endomicroscopy: a multicenter experience. Gastrointest Endosc 2011;74:961−8.
- Lörincz B, Husťák R, Bošák V, et al. Prvé skúsenosti s katétrovou konfokálnou laserovou endomikroskopiou (pCLE) v biliodigestívnej endoskopii. Gastroent Hepatol 2017;71:220−3.
- Fuchs FS, Zirlik S, Hildner K, et al. Confocal laser endomicroscopy for diagnosing lung cancer in vivo. Eur Respir J 2013;41:1401−8.
- Keller CA, Erasmus D, Alvarez F, et al. Preliminary observations in the use of confocal alveolar endomicroscopy in recipients of single lung transplantation. Presented at American Thoracic Society 2010 International Conference, New Orleans 2010.
- Newton RC, Camp SV, Yang GZ, et al. Imaging parenchymal lung diseases with confocal endomicroscopy. Am J Respir Crit Care Med 2010;181:A4316.
- Fuchs FS, Zirlik S, Hildner K, et al. Fluoresceinaided confocal laser endomicroscopy of the lung. Respiration 2011;81:32−8.
- Buchner AM, Gomez V, Heckman MG, et al. The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 2011;73:556−60.
- 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;106:1961−9.
- Giovannini M, Bories E, Monges G, et al. Results of a phase I-II study on intraductal confocal microscopy (IDCM) in patients with common bile duct (CBD) stenosis. Surg Endosc 2011;25:2247–53.
- Othman MO, Wallace MB. Confocal laser endomicroscopy: is it prime time? J Clin Gastroenterol 2011;45:205–6.
- Caillol F, Bories E, Autret A, et al. Evaluation of pCLE in the bile duct: final results of EMID study: pCLE: impact in the management of bile duct strictures. Surg Endosc 2015;29:2661−8.
- Karia K, Kahaleh M. A review of probe-based confocal laser endomicroscopy for pancreaticobiliary disease. Clin Endosc 2016;49:462–6.
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