Document Detail

Confocal laser endomicroscopy in Barrett's esophagus and endoscopically inapparent Barrett's neoplasia: a prospective, randomized, double-blind, controlled, crossover trial.
MedLine Citation:
PMID:  19559419     Owner:  NLM     Status:  MEDLINE    
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.
Kerry B Dunbar; Patrick Okolo; Elizabeth Montgomery; Marcia Irene Canto
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-06-25
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  70     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-30     Completed Date:  2009-12-21     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  645-54     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Barrett Esophagus / pathology*
Cross-Over Studies
Double-Blind Method
Esophageal Neoplasms / pathology*
Microscopy, Confocal*
Middle Aged
Prospective Studies
Grant Support
K12 RR023266/RR/NCRR NIH HHS; K12 RR023266/RR/NCRR NIH HHS; K12 RR023266-02/RR/NCRR NIH HHS
Comment In:
Gastrointest Endosc. 2009 Oct;70(4):655-7   [PMID:  19788981 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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