title: Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis.
abstract: Confocal laser endomicroscopy (CLE) is an endoscopic-assisted technique developed to obtain histopathological diagnoses of gastrointestinal and pancreatobiliary diseases in real time. The objective of this systematic review is to analyze the current literature on CLE and to evaluate the applicability and diagnostic yield of CLE in patients with gastrointestinal and pancreatobiliary diseases. A literature search was performed on MEDLINE, EMBASE, Scopus, and Cochrane Oral Health Group Specialized Register, using pertinent keywords without time limitations. Both prospective and retrospective clinical studies that evaluated the sensitivity, specificity, or accuracy of CLE were eligible for inclusion. Of 662 articles identified, 102 studies were included in the systematic review. The studies were conducted between 2004 and 2015 in 16 different countries. CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett's esophagus, gastric neoplasms and polyps, colorectal cancers in inflammatory bowel disease, malignant pancreatobiliary strictures, and pancreatic cysts. Although CLE has several promising applications, its use has been limited by its low availability, high cost, and need of specific operator training. Further clinical trials with a particular focus on cost-effectiveness and medicoeconomic analyses, as well as standardized institutional training, are advocated to implement CLE in routine clinical practice.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, University of Parma, 43100 Parma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fugazza
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, University of Parma, 43100 Parma, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gaiani
authors.affiliation: University Paris VII-Denis Diderot, 75006 Paris, France.
authors.forename: Maria Clotilde
authors.initials: MC
authors.lastname: Carra
authors.affiliation: Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, 94010 Créteil, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Brunetti
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, 94010 Créteil, France.
authors.forename: Michaël
authors.initials: M
authors.lastname: Lévy
authors.affiliation: Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; Cancer Research Lab. EC2M3, Université Paris-Est, Val de Marne UPEC, 94010 Créteil, France.
authors.forename: Iradj
authors.initials: I
authors.lastname: Sobhani
authors.affiliation: Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, 94010 Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Emergency Surgery Department, University of Parma, 43100 Parma, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, University of Parma, 43100 Parma, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: de'Angelis
authors.affiliation: Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, 94010 Créteil, France; Cancer Research Lab. EC2M3, Université Paris-Est, Val de Marne UPEC, 94010 Créteil, France; Department of Advanced Biomedical Sciences, University Federico II of Naples, 80138 Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de'Angelis
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology; D004724:Endoscopy / Q000379:methods*; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D016239:MEDLINE; D018613:Microscopy, Confocal / Q000379:methods*; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000473:pathology