Pilonis Nastazja Dagny, Januszewicz Wladyslaw, di Pietro Massimiliano
MRC Cancer Unit at the University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.
Transl Gastroenterol Hepatol. 2022 Jan 25;7:7. doi: 10.21037/tgh.2020.04.02. eCollection 2022.
Confocal laser endomicroscopy (CLE) is an advanced endoscopic imaging technology that provides a magnified, cellular level view of gastrointestinal epithelia. In conjunction with topical or intravenous fluorescent dyes, CLE allows for an "optical biopsy" for real-time diagnosis. Two different CLE system have been used in clinical endoscopy, probe-based CLE (pCLE) and endoscope-based CLE (eCLE). Using pCLE, the device can be delivered: (I) into the luminal gastrointestinal tract through the working channel of standard endoscopes; (II) into extraluminal cystic and solid parenchymal lesions through an endoscopic ultrasound (EUS) needle; or (III) into the biliary system through an endoscopic retrograde cholangiopancreatography (ERCP) accessory channel. With eCLE, the probe is directly integrated into the tip of a conventional endoscope, however, these endoscopes are no longer commercially available. CLE has moderate to high diagnostic accuracy for neoplastic and inflammatory conditions through the gastrointestinal tract including: oesophageal, gastric and colonic neoplasia, pancreatic cysts and solid lesions, malignant pancreatobiliary strictures and inflammatory bowel disease. Some studies have demonstrated the diagnostic benefit of CLE imaging when combined with either conventional white light endoscopy or advanced imaging technologies. Therefore, optical biopsies using CLE can resolve diagnostic dilemmas in some cases where conventional imaging fails to achieve conclusive results. CLE could also reduce the requirement for extensive tissue sampling during surveillance procedures. In the future, CLE in combination with molecular probes, could allow for the molecular characterization of diseases and assess response to targeted therapy. However, the narrow field of view, high capital costs and specialized operator training requirements remain the main limitations. Future multi-center, randomized trials with a focus on conventional diagnostic applications, cost-effectiveness and standardized training will be required for definitive evidence. The objective of this review is to evaluate the technical aspects and current applications of CLE in patients with gastrointestinal and pancreatobiliary diseases and discuss future directions for this technique.
共聚焦激光内镜检查（CLE）是一种先进的内镜成像技术，可提供胃肠道上皮细胞水平的放大视图。结合局部或静脉注射荧光染料，CLE可进行“光学活检”以实现实时诊断。临床内镜检查中使用了两种不同的CLE系统，基于探头的CLE（pCLE）和基于内镜的CLE（eCLE）。使用pCLE时，该设备可通过以下方式送达：（I）通过标准内镜的工作通道进入胃肠道管腔；（II）通过内镜超声（EUS）针进入腔外囊性和实性实质病变；或（III）通过内镜逆行胰胆管造影（ERCP）附件通道进入胆道系统。对于eCLE，探头直接集成在传统内镜的尖端，然而，这些内镜已不再商业化。CLE对包括食管、胃和结肠肿瘤、胰腺囊肿和实性病变、恶性胰胆管狭窄和炎症性肠病在内的胃肠道肿瘤和炎症性疾病具有中度至高诊断准确性。一些研究表明，CLE成像与传统白光内镜或先进成像技术联合使用时具有诊断优势。因此，在某些传统成像未能得出确定性结果的情况下，使用CLE进行光学活检可以解决诊断难题。CLE还可以减少监测程序中广泛组织采样的需求。未来，CLE与分子探针结合，可实现疾病的分子特征分析并评估对靶向治疗的反应。然而，视野狭窄、高资本成本和对操作人员的专业培训要求仍然是主要限制。未来需要进行以传统诊断应用、成本效益和标准化培训为重点的多中心随机试验，以获得确凿证据。本综述的目的是评估CLE在胃肠道和胰胆管疾病患者中的技术方面和当前应用，并讨论该技术的未来发展方向。
