Background and study aims: Surveillance of Barrett’s esophagus includes endoscopic inspection with biopsy of
suspicious lesions followed by four-quadrant biopsy of the remaining mucosa. We assessed
the ability of probe-based confocal laser endomicroscopy (pCLE) to replace biopsy
in the endoscopic evaluation of patients with Barrett’s esophagus in a prospective
and controlled setting.
Patients and methods: A total of 68 patients who were referred for endoscopic assessment of Barrett’s esophagus
were included across three centers. pCLE recordings were interpreted live during the
examination as well as in a blinded manner at least 3 months after endoscopy. pCLE
diagnosis of neoplasia based on pre-defined criteria was compared with histopathology
from suspicious as well as four-quadrant biopsies.
Results: A total of 670 pairs of biopsies and pCLE video sequences were available for analysis,
with neoplasia (high-grade dysplasia or cancer) being histologically diagnosed in
8.3 %. Specificity and negative predictive value of pCLE in excluding neoplasia was
0.97 (90 %CI 0.95 – 0.98) and 0.93 (0.91 – 0.95) for the blinded evaluation, and 0.95
(0.90 – 0.98) and 0.92 (0.90 – 0.94) for the on-site assessment. Positive predictive
values (PPVs) and sensitivity were rather poor for both settings (46 %/28 % [blinded]
and 18 %/12 % [on-site], respectively).
Conclusions: pCLE can be regarded as non-inferior to endoscopic biopsy in excluding neoplasia
of Barrett’s esophagus mucosa. However, due to its low PPV and sensitivity, pCLE may
currently not replace standard biopsy techniques for the diagnosis of Barrett’s esophagus
and associated neoplasia. Further technical development of pCLE and a better understanding
of its role in relation to other imaging technologies are necessary.
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A. MeiningMD
II Medizinische Klinik
Klinikum rechts der Isar
Ismaningerstr. 22
81675 München
Germany
Fax: +49-89-41404905
eMail: alexander.meining@lrz.tum.de
