CONFOCAL LASER ENDOMICROSCOPY IN THE ASSESSMENT OF PERSISTENT OR RECURRENT INTESTINAL METAPLASIA/NEOPLASIA AFTER ENDOSCOPIC TREATMENT OF BARRETT'S ESOPHAGUS RELATED NEOPLASIA – A PROSPECTIVE STUDY

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Aims: Patients after endoscopic treatment of Barrett's esophagus related neoplasia (BORN) should undergo regular endoscopic surveillance. Probe-based confocal laser endomicroscopy (pCLE) offers detailed examination of cellular structures and may examine larger areas compared to standard biopsy. The aim of this study was to evaluate the efficacy of pCLE (vs. standard biopsies) in detection of persistent/recurrent intestinal metaplasia (IM)/neoplasia (N) in patients after endoscopic treatment of BORN. Methods: A single center, prospective, controlled and pathologist-blinded study in patients undergoing surveillance endoscopy after treatment of BORN. pCLE images were obtained from the neo-Z-line, the cardia and the esophagus. Thereafter, standard biopsies were taken and sent for histopathological analysis (minimally 4 biopsies from neo-Z-line, 2 biopsies from the cardia and the esophagus and targeted biopsies from visible abnormalities, if present). Results: We examined 42 patients, from these 16 patients (38%) had the initial diagnosis of LGIN, 10 patients (24%) had HGIN and 16 patients (38%) had EAC. Six patients (14%) underwent endoscopic resection (ER) only, 20 patients (48%) underwent ER of all visible lesions followed by radiofrequency ablation (RFA), and 16 patients (38%) had RFA as a single treatment modality. Persistent/recurrent IM was detected only at the level of neo-Z-line in 11 patients (26%, 11/42 pts) by both standard biopsies and pCLE. pCLE but not biopsies detected IM in 2 patients (5%, 2/42), another 2 patients had IM present in biopsies but not in pCLE. pCLE diagnosed one patient with recurrent LGIN in a macroscopic visible tongue, which was not confirmed in biopsies. Sensitivity and specificity of pCLE in detection of persistent/recurrent IM was 93% and 85%, respectively, with a positive predictive value of 93% and a negative predictive value of 86%. Agreement of pCLE and histopathological findings was 90%. Conclusions: pCLE is comparable to standard biopsies in detection of persistent/recurrent IM after endoscopic treatment of BORN.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.