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. 2012 May 7:2:42.
doi: 10.3389/fonc.2012.00042. eCollection 2012.

Confocal Laser Endomicroscopy for Diagnosis of Barrett's Esophagus

Helmut Neumann  1 , Cord Langner, Markus F Neurath, Michael Vieth
Affiliations

Confocal Laser Endomicroscopy for Diagnosis of Barrett's Esophagus

Helmut Neumann et al. Front Oncol. .

Abstract

Barrett's esophagus (BE) is established as a premalignant condition in the distal esophagus. Current surveillance guidelines recommend random biopsies every 1-2 cm at intervals of 3-5 years. Advanced endoscopic imaging of BE underwent several technical revolutions within the last decade including broad-field (red-flag) techniques (e.g., chromoendoscopy) and small-field techniques with confocal laser endomicroscopy (CLE) at the forefront. In this review we will focus on advanced endoscopic imaging using CLE for the diagnosis and characterization of BE and associated neoplasia. In addition, we will critically discuss the technique of CLE and provide some tricks and hints for the daily routine practice of CLE for diagnosis of BE.

Keywords: Barrett; CLE; advanced imgaging; cancer; dysplasia; endomicroscopy; fluorescein.

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Figures

Figure 1
Figure 1
Typical endoscopic appearance of Barrett’s esophagus imaged using narrow band imaging (NBI) with single mucosal tears proximal to the esophagogastric junction.
Figure 2
Figure 2
(A) Confocal laser endomicroscopy using the integrated device (iCLE). Regular shaped columnar lined epithelium with goblet cells (arrows) is clearly visible. (B) Histological image of Barrett’s epithelium with numerous typical goblet cells that replaced the regular squamous epithelium in the distal esophagus (H&E 200×).
Figure 3
Figure 3
(A) pCLE image of high-grade intraepithelial neoplasia in patient with BE. Confocal imaging demonstrated dark, irregularly thickened epithelial cells, and dilated irregular vessels. (B) Histological image of Barrett’s esophagus with high-grade intraepithelial neoplasia. Cytological and architectural atypia is visible. The nuclei are larger in size with increased chromaticity, and loss of cell polarity. Architectural distortion is characterized by a back-to-back crypt pattern and focal cribriform areas.
Figure 4
Figure 4
(A) In vivo endomicroscopy of advanced esophageal adenocarcinoma in patient with long-segment Barrett’s esophagus using the probe-based device (pCLE). Note the clear cap at the distal tip of the endoscope to avoid motion artifacts. (B) Corresponding endomicroscopic appearance of adenocarcinoma in a patient with Barrett’s esophagus. Irregular, dark cells with high contrast to the surrounding tissue indicate advanced neoplasia. (C) Histological image of moderately differentiated adenocarcinoma in a patient with Barrett’s esophagus with loss of regular architecture and superficial erosion.
See this image and copyright information in PMC

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