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Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial.
Gastrointest Endosc. 2009 Oct; 70(4):645-54.GE

Abstract

BACKGROUND

The detection of high-grade dysplasia and cancer in Barrett's esophagus (BE) can be challenging. Confocal laser endomicroscopy (CLE) allows in vivo visualization of mucosal histology during endoscopy.

OBJECTIVE

To determine whether CLE with optical biopsy and targeted mucosal biopsy improves the diagnostic yield of endoscopically inapparent, BE-associated neoplasia compared to standard endoscopy with a 4-quadrant, random biopsy protocol.

DESIGN

Prospective, double-blind, randomized, crossover study.

SETTING

Single, tertiary-care academic center.

PATIENTS

This study involved patients with BE undergoing routine surveillance or referred for treatment of nonlocalized, endoscopically inapparent, BE-associated neoplasia.

INTERVENTION

All participants underwent both a confocal endomicroscopy with a targeted biopsy procedure and standard endoscopy with a 4-quadrant biopsy procedure in a randomized order.

MAIN OUTCOME MEASUREMENTS

Increase in diagnostic yield for neoplasia, reduction in mucosal biopsy number, final pathologic diagnosis.

RESULTS

CLE with targeted biopsy almost doubled the diagnostic yield for neoplasia and was equivalent to the standard protocol for the final diagnosis of neoplasia. Two thirds of patients in the surveillance group did not need any mucosal biopsies at all.

LIMITATION

Single-center study.

CONCLUSION

CLE with targeted biopsy significantly improves the diagnostic yield for endoscopically inapparent BE neoplasia compared to a standard endoscopy with a random-biopsy protocol. CLE with targeted biopsy also greatly reduces the number of biopsies needed per patient and allows some patients without neoplasia to completely forgo mucosal biopsy.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. kdunbar@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19559419

Citation

Dunbar, Kerry B., et al. "Confocal Laser Endomicroscopy in Barrett's Esophagus and Endoscopically Inapparent Barrett's Neoplasia: a Prospective, Randomized, Double-blind, Controlled, Crossover Trial." Gastrointestinal Endoscopy, vol. 70, no. 4, 2009, pp. 645-54.
Dunbar KB, Okolo P, Montgomery E, et al. Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointest Endosc. 2009;70(4):645-54.
Dunbar, K. B., Okolo, P., Montgomery, E., & Canto, M. I. (2009). Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. Gastrointestinal Endoscopy, 70(4), 645-54. https://doi.org/10.1016/j.gie.2009.02.009
Dunbar KB, et al. Confocal Laser Endomicroscopy in Barrett's Esophagus and Endoscopically Inapparent Barrett's Neoplasia: a Prospective, Randomized, Double-blind, Controlled, Crossover Trial. Gastrointest Endosc. 2009;70(4):645-54. PubMed PMID: 19559419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial. AU - Dunbar,Kerry B, AU - Okolo,Patrick,3rd AU - Montgomery,Elizabeth, AU - Canto,Marcia Irene, Y1 - 2009/06/25/ PY - 2008/11/10/received PY - 2009/02/06/accepted PY - 2009/6/30/entrez PY - 2009/6/30/pubmed PY - 2009/12/22/medline SP - 645 EP - 54 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 70 IS - 4 N2 - BACKGROUND: The detection of high-grade dysplasia and cancer in Barrett's esophagus (BE) can be challenging. Confocal laser endomicroscopy (CLE) allows in vivo visualization of mucosal histology during endoscopy. OBJECTIVE: To determine whether CLE with optical biopsy and targeted mucosal biopsy improves the diagnostic yield of endoscopically inapparent, BE-associated neoplasia compared to standard endoscopy with a 4-quadrant, random biopsy protocol. DESIGN: Prospective, double-blind, randomized, crossover study. SETTING: Single, tertiary-care academic center. PATIENTS: This study involved patients with BE undergoing routine surveillance or referred for treatment of nonlocalized, endoscopically inapparent, BE-associated neoplasia. INTERVENTION: All participants underwent both a confocal endomicroscopy with a targeted biopsy procedure and standard endoscopy with a 4-quadrant biopsy procedure in a randomized order. MAIN OUTCOME MEASUREMENTS: Increase in diagnostic yield for neoplasia, reduction in mucosal biopsy number, final pathologic diagnosis. RESULTS: CLE with targeted biopsy almost doubled the diagnostic yield for neoplasia and was equivalent to the standard protocol for the final diagnosis of neoplasia. Two thirds of patients in the surveillance group did not need any mucosal biopsies at all. LIMITATION: Single-center study. CONCLUSION: CLE with targeted biopsy significantly improves the diagnostic yield for endoscopically inapparent BE neoplasia compared to a standard endoscopy with a random-biopsy protocol. CLE with targeted biopsy also greatly reduces the number of biopsies needed per patient and allows some patients without neoplasia to completely forgo mucosal biopsy. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/19559419/Confocal_laser_endomicroscopy_in_Barrett's_esophagus_and_endoscopically_inapparent_Barrett's_neoplasia:_a_prospective_randomized_double_blind_controlled_crossover_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(09)00263-6 DB - PRIME DP - Unbound Medicine ER -