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Study shows in vivo endomicroscopy improves detection of Barrett's esophagus-related neoplasia
Date:2/19/2014

) is a relatively new endoscopic imaging technique that combines endoscopy and microscopic imaging of the gastrointestinal (GI) mucosa (the superficial lining of the GI tract). A previous single-center, randomized, crossover study, demonstrated a greater diagnostic yield for the detection of BE neoplasia with an in vivo fluorescein-aided endoscope-based CLE system (eCLE).

"Our study compared the diagnostic yield and accuracy of high definition white-light endoscopy (HDWLE) and random biopsy with that of HDWLE plus real-time eCLE imaging and targeted tissue sampling of BE, and determined the impact of in vivo eCLE on real-time clinical decision making in patients with BE," said study lead author Marcia Irene Canto, MD, MHS, FASGE, Johns Hopkins University, Baltimore, Maryland. "We found that real-time eCLE and targeted biopsy after HDWLE can improve the diagnostic yield and accuracy for neoplasia and significantly impact in vivo decision making by altering the diagnosis and guiding therapy."

Methods

This was a multicenter, randomized, controlled trial of 192 adult patients with BE undergoing routine surveillance or referred for early neoplasia from February 2010 to December 2012 at academic medical centers. The researchers' objective was to compare high-definition white-light endoscopy (HDWLE) alone with random biopsy (RB) and HDWLE plus eCLE and targeted biopsy (TB) for diagnosis of BE neoplasia. Patients were randomized to HDWLE plus RB (group 1) or HDWLE with eCLE and TB (group 2). Real-time diagnoses and management plans were recorded after HDWLE in both groups and after eCLE in group 2. Blinded expert pathology diagnosis was the reference standard. The main outcomes were diagnostic yield, performance characteristics, and clinical impact.

Results

HDWLE plus eCLE and TB (group 2) led to a lower number of mucosal biopsies and higher diagnostic yield for neoplasia (34 percent vs 7 percent), compared with HDWL
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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