TY - JOUR
T1 - Real-time increased detection of neoplastic tissue in Barrett's esophagus with probe-based confocal laser endomicroscopy
T2 - Final results of an international multicenter, prospective, randomized, controlled trial
AU - Sharma, Prateek
AU - Meining, Alexander R.
AU - Coron, Emmanuel
AU - Lightdale, Charles J.
AU - Wolfsen, Herbert C.
AU - Bansal, Ajay
AU - Bajbouj, Monther
AU - Galmiche, Jean Paul
AU - Abrams, Julian A.
AU - Rastogi, Amit
AU - Gupta, Neil
AU - Michalek, Joel E.
AU - Lauwers, Gregory Y.
AU - Wallace, Michael B.
PY - 2011/9
Y1 - 2011/9
N2 - 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.)
AB - 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.)
UR - http://www.scopus.com/inward/record.url?scp=80052202340&partnerID=8YFLogxK
U2 - 10.1016/j.gie.2011.04.004
DO - 10.1016/j.gie.2011.04.004
M3 - Article
C2 - 21741642
AN - SCOPUS:80052202340
SN - 0016-5107
VL - 74
SP - 465
EP - 472
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
IS - 3
ER -