Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis

Abstract

Aim: To evaluate the clinical impact of confocal laser endomicroscopy (CLE) in the diagnosis and management of patients with an uncertain diagnosis.

Methods: A retrospective chart review was performed. Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included. Baseline characteristics, indications, previous diagnostic studies, findings at the time of CLE, clinical management and histological results were analyzed. Interventions based on CLE findings were also analyzed. We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.

Results: A total of 144 patients were included. Of these, 51% (74/144) were female. The mean age was 51 years old. In all, 41/144 (28.4%) lesions were neoplastic (13 bile duct, 10 gastric, 8 esophageal, 6 colonic, 1 duodenal, 1 rectal, 1 ampulloma and 1 pancreatic). The sensitivity, specificity, positive predictive value, negative predictive value, and observed agreement when CLE was used to detect N-lesions were 85.37%, 87.38%, 72.92%, 93.75% and 86.81%, respectively. Cohen's Kappa was 69.20%, thus indicating good agreement. Changes in management were observed in 54% of the cases.

Conclusion: CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.

Keywords: Barret esophagus; Biliary strictures; Confocal laser endomicroscopy; Gastrointestinal cancer; In vivo microscopy; Pancreatic cyst.

Figure 1

Colonic polyp. A: A sigmoid flat polyp was viewed using digital chromoendoscopy with high definition by i-scan, which revealed a pit pattern suggestive of a hyperplastic lesion in a patient with cirrhosis and important coagulation disorders; B: CLE showing dysplasia (image optimized by using a green-white image color palette in Cellvizio^® viewer software); C: A histological analysis of the specimen confirmed the dysplasia. CLE: Confocal laser endomicroscopy.

Figure 2

Undetermined stenosis of the biliary tract. A: ERCP was performed in a patient with undetermined stenosis who was cytobrush-negative for malignancy; B: Spyglass cholangioscopy showing a reddish area that was not suspected of malignancy; C: CLE showing dark clumps that were suspected of malignancy (image optimized using the “black-red-yellow” image color palette in Cellvizio^® viewer software); D: The histological results of a target biopsy confirmed a diagnosis of cholangiocarcinoma. CLE: Confocal laser endomicroscopy; ERCP: Endoscopic retrograde cholangiopancreatography.