Department of Gastroenterology, Clinical Hospital Centre Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
Department of Radiology, Clinical Hospital Centre Rijeka, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
Dig Dis. 2022;40(1):97-105. doi: 10.1159/000516257. Epub 2021 Apr 1.
Barrett's esophagus (BE) requires surveillance to identify potential neoplasia at an early stage. The standard surveillance regimen includes random 4-quadrant biopsies by Seattle protocol. Main limitations of random biopsies are high risk of sampling error, difficulties in histology interpretation, common inadequate classification of pathohistological changes, increased risk of bleeding, and time necessary to acquire the final diagnosis. Probe-based confocal laser endomicroscopy (pCLE) has emerged as a potential tool with an aim to overcome these obvious limitations.
pCLE represents a real-time microscopic imaging method that offers evaluation of epithelial and subepithelial structures with 1,000-fold magnification. In theory, pCLE has potential to eliminate the need for biopsy in BE patients. The main advantages would be real-time diagnosis and decision-making, greater diagnostic accuracy, and evaluation of larger area compared to random biopsies. Clinical pCLE studies in the esophagus show high diagnostic accuracy, and its high negative predictive value offers high reliability and confidence to exclude dysplastic and neoplastic lesions. However, it still cannot replace histopathology due to lower positive predictive value and sensitivity. Key Messages: Despite promising results, its role in routine use in patients with BE remains questionable primarily due to lack of well-organized double-blind randomized trials.
巴雷特食管（BE）需要进行监测，以便在早期发现潜在的肿瘤。标准的监测方案包括按西雅图协议进行随机 4 象限活检。随机活检的主要局限性是采样误差风险高、组织学解释困难、常见的组织病理学改变分类不足、出血风险增加以及获得最终诊断所需的时间。基于探头的共聚焦激光内镜检查（pCLE）的出现为克服这些明显的局限性提供了一种潜在的工具。
pCLE 代表一种实时微观成像方法，可提供上皮和上皮下结构的 1000 倍放大评估。从理论上讲，pCLE 有可能消除 BE 患者进行活检的需要。其主要优势是实时诊断和决策、更高的诊断准确性以及与随机活检相比评估更大的面积。食管的临床 pCLE 研究显示出较高的诊断准确性，其高阴性预测值为排除异型增生和肿瘤性病变提供了较高的可靠性和信心。然而，由于较低的阳性预测值和灵敏度，它仍然不能替代组织病理学。
尽管结果很有希望，但由于缺乏精心组织的双盲随机试验，其在 BE 患者常规使用中的作用仍存在疑问。
