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


OBJECTIVE
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.
Division of Endoscopy, European Institute of Oncology, Milan, Italy. cristina.trovato@ieo.it
Cristina
C
Trovato
Angelica
A
Sonzogni
Davide
D
Ravizza
Giancarla
G
Fiori
Darina
D
Tamayo
Giuseppe
G
De Roberto
Annalisa
A
de Leone
Stefania
S
De Lisi
Cristiano
C
Crosta
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011446:Prospective Studies