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

E and RB (group 1) but with comparable accuracy. HDWLE plus eCLE and TB tripled the diagnostic yield for neoplasia (22 percent vs 6 percent) and would have obviated the need for any biopsy in 65 percent of patients. The addition of eCLE to HDWLE increased the sensitivity for neoplasia detection to 96 percent from 40 percent without significant reduction in specificity. In vivo CLE changed the treatment plan in 36 percent of patients. An eCLE was performed successfully and safely in all patients. There were no adverse reactions to fluorescein administration.

The researchers noted several limitations including that the study was only at academic centers with highly experienced endoscopists. The results may not be generalizable to community-based physicians, less-experienced practitioners and nonacademic practices. Second, they used the eCLE system, and their findings may not be generalizable to other pCLE systems. Also, the endoscopists were not blinded to prior endoscopy and pathology results because these were necessary for standard medical care and in vivo decision making regarding biopsy or EMR.

The researchers concluded that the addition of in vivo imaging with eCLE to HDWLE is associated with improved targeting of neoplasia, a decrease in unnecessary mucosal biopsies and a significant change in diagnosis and management plans in patients with BE. The approach of real-time CLE diagnosis and imaging-guided therapy represents a potential paradigm shift in BE surveillance. Research studies are needed to address training in CLE, comparative effectiveness studies of advanced endoscopic imaging techniques, the role of imaging-guided therapy and advances in CLE devices and contrast agents.

In an accompanying editorial, Manuel Berzosa, MD and Michael B. Wallace, MD, MPH, Mayo Clinic, Jacksonville, Florida, stated, "This is an important study for Barrett's esophagus surveillance because it demonstrates that a targeted biopsy strategy using endosc
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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