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Review
. 2025 Sep 29:13:1681649.
doi: 10.3389/fped.2025.1681649. eCollection 2025.

The role of confocal laser endomicroscopy in pediatric gastrointestinal diseases: a narrative review

Irene Dalpiaz  1 , Luca Scarallo  1   2 , Marco Andreini  1 , Sara Renzo  1 , Giusy Russo  3 , Cosimo Ruggiero  3 , Danila Volpe  3 , Paolo Lionetti  1   2 , Salvatore Oliva  3
Affiliations
Review

The role of confocal laser endomicroscopy in pediatric gastrointestinal diseases: a narrative review

Irene Dalpiaz et al. Front Pediatr. .

Erratum in

Abstract

Introduction: Confocal laser endomicroscopy (CLE) is an innovative tool that enables microscopic evaluation of the gastrointestinal mucosa during the digestive endoscopy, providing real-time diagnostic information alongside histopathological findings.

Methods: A literature search on CLE in pediatric gastroenterology was performed.

Results: CLE has a broad range of applications, spanning from the upper digestive tract to the lower digestive tract, but its applications in the pediatric setting remains largely unexplored and confined to experimental setting.

Discussion: Despite the extensive potential of CLE, its application in pediatric patients has been poorly investigated. This narrative review aims to consolidate the current knowledge on CLE in gastrointestinal diseases and to draw insights from adult studies to promote future research in the pediatric field.

Keywords: confocal laser endomicroscopy; food allergy; functional gastrointestinal disorders; inflammatory bowel diseases; pediatric gastrointestinal diseases.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Confocal Laser endomicroscopy vs. conventional histology magnification. (A) Confocal image of non-keratinized squamous epithelium of the esophagus. (B) Histological image of esophagus. Images from: Venkatesh K, et al. Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders. World J Gastroenterol 2009; 15:2214–2219. doi: 10.3748/wjg.15.2214.
Figure 2
Figure 2
Pros and cons of confocal Laser endomicroscopy and its application in pediatric gastroenterology (figure created with canva - www.canva.com). Current applications are highlighted in bold while potential applications are shown in italics.
Figure 3
Figure 3
Explanatory pictures of the main applications of confocal Laser endomicroscopy in pediatric gastroenterology. (A) GERD—Image form: Venkatesh K, et al. Gastrointest Endosc 2012 (20) (B) Eosinophilc esophagitis—Image from: Yoo H et al. Gastrointest Endosc 2011 (22). (C) IBS: duodenum (Figure acquired at the Pediatric Gastroenterology and Liver Unit—University Hospital Umberto I, Sapienza University of Rome, Italy). (D) Crohn's disease: mild colonic activity (figures acquired at the Pediatric Gastroenterology and Liver Unit—University Hospital Umberto I, Sapienza University of Rome, Italy). (E) Ulcerative colitis: ileum (left image) and colon (right image) (Figures acquired at the Pediatric Gastroenterology and Liver Unit—University Hospital Umberto I, Sapienza University of Rome, Italy). (F) Celiac disease: duodenal villi with loss of the cellular architecture (large arrows) of the surface epithelium, decrease in goblet cells (arrowheads) and intervillous bridging (small arrows)—Image from: Venkatesh K et al. J Pediatr Gastroenterol Nutr 2010 (28).
Figure 4
Figure 4
Explanatory pictures of the main applications of confocal Laser endomicroscopy in pediatric gastroenterology—food allergy (figures acquired at the pediatric gastroenterology and liver unit—university hospital umberto I, sapienza university of Rome, Italy).
See this image and copyright information in PMC

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