Confocal Laser Endomicroscopy vs Biopsies in the Assessment of Persistent or Recurrent Intestinal Metaplasia/Neoplasia after Endoscopic Treatment of Barrett’s Esophagus related Neoplasia

Authors

  • Jana Krajciova Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague; Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
  • Marek Kollar Department of Clinical and Transplant Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • Jana Maluskova Department of Clinical and Transplant Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • Martin Janicko 1st Department of Internal Medicine, P.J. Safarik University in Kosice, Faculty of Medicine and L. Pasteur University Hospital, Kosice, Slovakia
  • Zuzana Vackova Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague; Institute of Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
  • Julius Spicak Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  • Jan Martinek Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague; Institute of Physiology, First Faculty of Medicine, Charles University, Prague; Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic

DOI:

https://doi.org/10.15403/jgld-2467

Keywords:

Probe-based confocal laser endomicroscopy, Barrett's esophagus related neoplasia, radiofrequency ablation, endoscopic resection, neo-Z-line, intestinal metaplasia

Abstract

Background and Aims: Patients after endoscopic treatment of Barrett‘s esophagus (BE) related neoplasia (BORN) should enter endoscopic surveillance with biopsies to detect persistent or recurrent neoplasia or intestinal metaplasia (IM). Probe-based confocal laser endomicroscopy (pCLE) serves as a virtual biopsy and could replace standard biopsies. However, the role of pCLE in patients after endoscopic treatment of BORN has not been systematically assessed. The aim of this study was to compare pCLE with biopsies in detecting persistent/recurrent IM/neoplasia.

Methods: A single center, prospective and pathologist-blinded study was performed. Patients after endoscopic treatment of BORN (endoscopic resection or dissection, radiofrequency ablation) underwent surveillance endoscopy with pCLE followed by biopsies.

Results: A total of 56 patients were enrolled: initial diagnoses were low-grade dysplasia (LGD) in 24 patients (43%), high-grade dysplasia (HGD) in 12 patients (21%) and early adenocarcinoma (EAC) in 20 patients (36%). Only one patient (2%) experienced recurrent neoplasia (LGD), which was diagnosed by pCLE only. Twenty patients (35.7%) experienced persistent/recurrent IM, diagnosed by both pCLE and biopsies in 17 patients (17/30, 85%) and by pCLE only in 3 pts (3/30, 15%). Sensitivity, specificity, positive and negative predictive values to diagnose recurrent/persistent IM did not differ significantly between pCLE and biopsies; diagnostic accuracy was 100% (95%CI 93.6-100) for pCLE and 94.6 (95%CI 85.1-98.9%) for biopsies, p=0.25. In patients with IM detected by both tested methods, pCLE detected significantly more goblet cells (median 43 per patient) than biopsies (median 12 per patient), p=0.01.

Conclusion: pCLE is at least as effective as standard biopsies in the detection of persistent/recurrent IM after endoscopic treatment of BORN.

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Published

2020-09-09

How to Cite

1.
Krajciova J, Kollar M, Maluskova J, Janicko M, Vackova Z, Spicak J, Martinek J. Confocal Laser Endomicroscopy vs Biopsies in the Assessment of Persistent or Recurrent Intestinal Metaplasia/Neoplasia after Endoscopic Treatment of Barrett’s Esophagus related Neoplasia. JGLD [Internet]. 2020 Sep. 9 [cited 2026 Jul. 14];29(3):305-12. Available from: https://www.jgld.ro/jgld/index.php/jgld/article/view/2467

Issue

Vol. 29 No. 3: September 2020

Section

Original Article