title: A meta-analysis of confocal laser endomicroscopy for the detection of neoplasia in patients with Barrett's esophagus.
abstract: OBJECTIVE
  Barrett's esophagus (BE) is considered the most important risk factor for development of esophageal adenocarcinoma. Confocal laser endomicroscopy (CLE) is a recently developed technique used to diagnose neoplasia in BE. This meta-analysis was performed to assess the accuracy of CLE for diagnosis of neoplasia in BE.
  
  
  METHODS
  We searched EMBASE, PubMed, Cochrane Library, and Web of Science to identify relevant studies for all articles published up to June 27, 2015 in English. The quality of included studies was assessed using QUADAS-2. Per-patient and per-lesion pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence intervals (CIs) were calculated.
  
  
  RESULTS
  In total, 14 studies were included in the final analysis, covering 789 patients with 4047 lesions. Seven studies were included in the per-patient analysis. Pooled sensitivity and specificity were 89% (95% CI: 0.82-0.94) and 83% (95% CI: 0.78-0.86), respectively. Ten studies were included in the per-lesion analysis. Compared with the PP analysis, the corresponding pooled sensitivity declined to 77% (95% CI: 0.73-0.81) and specificity increased to 89% (95% CI: 0.87-0.90). Subgroup analysis showed that probe-based CLE (pCLE) was superior to endoscope-based CLE (eCLE) in pooled specificity [91.4% (95% CI: 89.7-92.9) vs 86.1% (95% CI: 84.3-87.8)] and AUC for the sROC (0.885 vs 0.762).
  
  
  CONCLUSIONS
  Confocal laser endomicroscopy is a valid method to accurately differentiate neoplasms from non-neoplasms in BE. It can be applied to BE surveillance and early diagnosis of esophageal adenocarcinoma.
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
authors.forename: Yi-Quan
authors.initials: YQ
authors.lastname: Xiong
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
authors.forename: Shu-Juan
authors.initials: SJ
authors.lastname: Ma
authors.affiliation: Department of Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan, China.
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
authors.forename: Xue-Shan
authors.initials: XS
authors.lastname: Zhong
authors.affiliation: Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Chen
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D019540:Area Under Curve; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results
keywords: Barrett's esophagus; confocal laser endomicroscopy; meta-analysis; neoplasia