title: Use of probe-based confocal laser endomicroscopy (pCLE) in gastrointestinal applications. A consensus report based on clinical evidence.
abstract: BACKGROUND
  Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training.
  
  
  OBJECTIVE
  This study aimed to provide guidance on the standardisation of its practice and training in Barrett's oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases.
  
  
  METHODS
  Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%.
  
  
  RESULTS
  Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence.
  
  
  CONCLUSIONS
  pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.affiliation: Division of Digestive Diseases, Beth Israel Medical Center, New York City, NY, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Carr-Locke
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: The Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy.
authors.forename: Helga
authors.initials: H
authors.lastname: Bertani
authors.affiliation: Division of Gastroenterology and Hepatology, Nantes CHU, Rouen, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Galmiche
authors.affiliation: Ohio State University, Columbus, OH, USA.
authors.forename: Razvan I
authors.initials: RI
authors.lastname: Arsenescu
authors.affiliation: Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Chang
authors.affiliation: Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.affiliation: Division of Gastroenterology and Hepatology, Nantes CHU, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coron
authors.affiliation: Digestive Endoscopy Unit, Catholic University, Roma, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Karolinska Institutet, Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Aldona
authors.initials: A
authors.lastname: Dlugosz
authors.affiliation: Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ian Gan
authors.affiliation: Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: Division of Digestive and Liver disease, Columbia University Medical Center, New York City, NY, USA.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
authors.affiliation: Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Oleh
authors.initials: O
authors.lastname: Haluszka
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Khek Y
authors.initials: KY
authors.lastname: Ho
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, NY, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Vani J
authors.initials: VJ
authors.lastname: Konda
authors.affiliation: Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Prat
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MI, USA ; Department of Gastroenterology and Hepatology, The University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Wolfsen
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Alvin
authors.initials: A
authors.lastname: Zfass
keywords: Barrett’s oesophagus; Endomicroscopy; advanced endoscopy; biliary strictures; colorectal polyps; credentialling; gastroenterology; inflammatory bowel diseases; optical biopsy; recommendations; small polyps; training