title: Emerging enhanced imaging technologies of the esophagus: spectroscopy, confocal laser endomicroscopy, and optical coherence tomography.
abstract: BACKGROUND
  Despite advances in diagnoses and therapy, esophageal adenocarcinoma remains a highly lethal neoplasm. Hence, a great interest has been placed in detecting early lesions and in the detection of Barrett esophagus (BE). Advanced imaging technologies of the esophagus have then been developed with the aim of improving biopsy sensitivity and detection of preplastic and neoplastic cells. The purpose of this article was to review emerging imaging technologies for esophageal pathology, spectroscopy, confocal laser endomicroscopy (CLE), and optical coherence tomography (OCT).
  
  
  METHODS
  We conducted a PubMed search using the search string "esophagus or esophageal or oesophageal or oesophagus" and "Barrett or esophageal neoplasm" and "spectroscopy or optical spectroscopy" and "confocal laser endomicroscopy" and "confocal microscopy" and "optical coherence tomography." The first and senior author separately reviewed all articles. Our search identified: 19 in vivo studies with spectroscopy that accounted for 1021 patients and 4 ex vivo studies; 14 clinical CLE in vivo studies that accounted for 941 patients and 1 ex vivo study with 13 patients; and 17 clinical OCT in vivo studies that accounted for 773 patients and 2 ex vivo studies.
  
  
  RESULTS
  Human studies using spectroscopy had a very high sensitivity and specificity for the detection of BE. CLE showed a high interobserver agreement in diagnosing esophageal pathology and an accuracy of predicting neoplasia. We also found several clinical studies that reported excellent diagnostic sensitivity and specificity for the detection of BE using OCT.
  
  
  CONCLUSIONS
  Advanced imaging technology for the detection of esophageal lesions is a promising field that aims to improve the detection of early esophageal lesions. Although advancing imaging techniques improve diagnostic sensitivities and specificities, their integration into diagnostic protocols has yet to be perfected.
authors.affiliation: Department of Surgery, University of California Irvine.
authors.forename: Lourdes Y
authors.initials: LY
authors.lastname: Robles
authors.affiliation: Division of Gastroenterology, Boston VA Healthcare System, Boston University, Boston, Massachusetts.
authors.forename: Satish
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Surgery, Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts. Electronic address: piero.fisichella@va.gov.
authors.forename: Piero Marco
authors.initials: PM
authors.lastname: Fisichella
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology*; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology; D006801:Humans; D018613:Microscopy, Confocal / Q000379:methods*; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Barrett esophagus; Confocal laser endomicroscopy; Confocal microscopy; Inelastic (Raman) scattering spectroscopy; Optical coherence tomography; Spectroscopy