Caillol Fabrice, Godat Sebastien, Poizat Flora, Auttret Aurélie, Pesenti Christian, Bories Erwan, Ratone Jean Phillipe, Giovannini Marc
Endoscopy Unit (Fabrice Caillol, Sebastien Godat, Christian Pesenti, Ewran Bories, Jean Phillipe Ratone, Marc Giovannini).
Pathology Unit (Flora Poizat).
Ann Gastroenterol. 2017;30(3):295-301. doi: 10.20524/aog.2017.0138. Epub 2017 Mar 24.
Endoscopic management of Barrett's esophagus (BE) depends on the histological stage of BE and includes the following: follow up, endotherapy with thermal ablation, and piecemeal or monobloc endoscopic resection (ER). We know that biopsies are unreliable in 20-75% of cases. The aim of our study was to evaluate the efficiency of probe confocal laser endomicroscopy (pCLE) in the diagnosis of the histological stage of BE, compared with the final histological results after ER.
This retrospective study was based on a prospective registry of patients referred for management of BE-associated dysplasia. The inclusion criteria were dysplasia associated with BE on pre-resection biopsy and endoscopic resection of the examined areas. CLE examinations (pCLEs) were performed using the Gastroflex probe (Maunakea company). ER was sufficient to ensure that the target area was resected. The following four potential diagnoses were considered: normal or inflammatory mucosa, metaplasia (BE), low-grade dysplasia (LGD), and high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC).
The sensitivity, specificity, and accuracy in the detection of HGD/EAC were 92.9%, 71.4% and 80% for pCLE, and 78.6%, 61.9%, and 68.6% for histological biopsy, respectively. The differences in favor of pCLE were not statistically significant (P=0.2); however, in 13 patients with irregularities of the mucosa without elevated or depressed lesions (2 HGD/EAC and 11 non-HGD/EAC), pCLE led to positive redirection of therapy in 70% (9/13) of cases.
In the absence of visible lesions, pCLE appears to lead to correct diagnoses and to aid real-time decisions regarding therapeutic management.
巴雷特食管（BE）的内镜治疗取决于BE的组织学阶段，包括以下内容：随访、热消融内镜治疗以及内镜下分片或整块切除（ER）。我们知道，在20%至75%的病例中活检结果不可靠。本研究的目的是评估共聚焦激光显微内镜探头（pCLE）在诊断BE组织学阶段方面的效率，并与ER后的最终组织学结果进行比较。
这项回顾性研究基于一个前瞻性登记系统，该系统登记了因BE相关发育异常而接受治疗的患者。纳入标准为切除术前活检显示与BE相关的发育异常以及对检查区域进行内镜切除。使用Gastroflex探头（莫纳克亚公司）进行共聚焦激光内镜检查（pCLE）。ER足以确保切除目标区域。考虑了以下四种可能的诊断：正常或炎性黏膜、化生（BE）、低级别发育异常（LGD）以及高级别发育异常/食管腺癌（HGD/EAC）。
pCLE检测HGD/EAC的敏感性、特异性和准确性分别为92.9%、71.4%和80%，组织活检的相应数据分别为78.6%、61.9%和68.6%。支持pCLE的差异无统计学意义（P = 0.2）；然而，在13例黏膜不规则但无隆起或凹陷性病变的患者中（2例HGD/EAC和11例非HGD/EAC），pCLE在70%（9/13）的病例中导致了治疗的积极调整。
在没有可见病变的情况下，pCLE似乎能做出正确诊断并有助于实时做出治疗管理决策。
