Confocal laser endomicroscopy for in vivo diagnosis of Barrett's oesophagus and associated neoplasia: A pilot study conducted in a single Italian centre

Cristina Trovato, Angelica Sonzogni, Davide Ravizza, Giancarla Fiori, Darina Tamayo, Giuseppe De Roberto, Annalisa de Leone, Stefania De Lisi, Cristiano Crosta

Research output: Contribution to journalArticle

Abstract

Background: Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims: To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods: Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1-2. cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results: Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1%. The agreement between endomicroscopic and histological results was substantial (. κ=. 0.76). Conclusions: This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.

Original languageEnglish
Pages (from-to)396-402
Number of pages7
JournalDigestive and Liver Disease
Volume45
Issue number5
DOIs
Publication statusPublished - May 2013

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Barrett Esophagus
Lasers
Neoplasms
Biopsy
Observer Variation
Metaplasia
Esophagus
Endoscopy
Mucous Membrane
Prospective Studies

Keywords

  • Barrett's oesophagus
  • Confocal laser endomicroscopy
  • Dysplasia
  • Early neoplasia

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

@article{124f0e1a60904e2e846deeb05f5b0cbc,
title = "Confocal laser endomicroscopy for in vivo diagnosis of Barrett's oesophagus and associated neoplasia: A pilot study conducted in a single Italian centre",
abstract = "Background: Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims: To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods: Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1-2. cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results: Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1{\%}. The agreement between endomicroscopic and histological results was substantial (. κ=. 0.76). Conclusions: This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.",
keywords = "Barrett's oesophagus, Confocal laser endomicroscopy, Dysplasia, Early neoplasia",
author = "Cristina Trovato and Angelica Sonzogni and Davide Ravizza and Giancarla Fiori and Darina Tamayo and {De Roberto}, Giuseppe and {de Leone}, Annalisa and {De Lisi}, Stefania and Cristiano Crosta",
year = "2013",
month = "5",
doi = "10.1016/j.dld.2012.12.016",
language = "English",
volume = "45",
pages = "396--402",
journal = "Digestive and Liver Disease",
issn = "1590-8658",
publisher = "Elsevier B.V.",
number = "5",

}

TY - JOUR

T1 - Confocal laser endomicroscopy for in vivo diagnosis of Barrett's oesophagus and associated neoplasia

T2 - A pilot study conducted in a single Italian centre

AU - Trovato, Cristina

AU - Sonzogni, Angelica

AU - Ravizza, Davide

AU - Fiori, Giancarla

AU - Tamayo, Darina

AU - De Roberto, Giuseppe

AU - de Leone, Annalisa

AU - De Lisi, Stefania

AU - Crosta, Cristiano

PY - 2013/5

Y1 - 2013/5

N2 - Background: Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims: To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods: Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1-2. cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results: Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1%. The agreement between endomicroscopic and histological results was substantial (. κ=. 0.76). Conclusions: This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.

AB - Background: Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims: To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods: Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1-2. cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results: Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1%. The agreement between endomicroscopic and histological results was substantial (. κ=. 0.76). Conclusions: This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.

KW - Barrett's oesophagus

KW - Confocal laser endomicroscopy

KW - Dysplasia

KW - Early neoplasia

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U2 - 10.1016/j.dld.2012.12.016

DO - 10.1016/j.dld.2012.12.016

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VL - 45

SP - 396

EP - 402

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

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