Ypsilantis Efthymios, Pissas Dimitrios, Papagrigoriadis Savvas, Haji Amyn
Department of Colorectal Surgery and Endoscopy, King's College Hospital, Denmark Hill, London, UK.
Surg Laparosc Endosc Percutan Tech. 2015 Feb;25(1):1-5. doi: 10.1097/SLE.0000000000000072.
Evaluation of the adequacy of endoscopic mucosal resection (EMR) of gastrointestinal lesions remains challenging by use of conventional endoscopy. Confocal laser endomicroscopy (CLE) is a novel imaging technique, designed to provide in vivo histology, and facilitate diagnosis with real-time intervention. We undertook a systematic review of the available literature, exploring the role of CLE in assuring completeness of EMR of gastrointestinal lesions. The number of pertinent studies is very limited, including only 1 randomized controlled study and 2 prospective comparative case series. Per-lesion meta-analysis showed that the sensitivity of CLE for detection of residual neoplasia was 91% (95% confidence interval, 82.5%-96%) with specificity of 69% (95% confidence interval, 61%-77%), with significant heterogeneity noted in all outcomes. In conclusion, the evidence underpinning the usefulness of CLE in ensuring adequate EMR of gastrointestinal neoplasia is currently very weak, with limited promising results related to gastric and colorectal polyp resections.
利用传统内镜评估胃肠道病变内镜黏膜切除术（EMR）的充分性仍然具有挑战性。共聚焦激光显微内镜检查（CLE）是一种新型成像技术，旨在提供体内组织学检查，并通过实时干预促进诊断。我们对现有文献进行了系统综述，探讨CLE在确保胃肠道病变EMR完整性方面的作用。相关研究数量非常有限，仅包括1项随机对照研究和2项前瞻性比较病例系列研究。每病变的荟萃分析表明，CLE检测残留肿瘤的敏感性为91%（95%置信区间，82.5%-96%），特异性为69%（95%置信区间，61%-77%），所有结果均存在显著异质性。总之，目前支持CLE在确保胃肠道肿瘤充分EMR方面有用性的证据非常薄弱，与胃和结肠息肉切除术相关的有前景的结果有限。
