Original article
In Vivo Histology of Barrett’s Esophagus and Associated Neoplasia by Confocal Laser Endomicroscopy

https://doi.org/10.1016/j.cgh.2006.05.010Get rights and content

Background & Aims: Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy. Here, we have applied this technique to the in vivo diagnosis of Barrett’s epithelium and associated neoplasia. Methods: Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus. Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed. In vivo histology was compared with the histologic specimens. All digitally stored images were re-assessed by a blinded investigator by the confocal Barrett classification system to predict histology. Intraobserver and interobserver variations of the involved endoscopists were evaluated by using κ statistics. Results: Endomicroscopy allowed distinguishing between different types of epithelial cells and detected cellular and vascular changes in Barrett’s epithelium at high resolution during ongoing endoscopy in 63 patients. Barrett’s esophagus and associated neoplasia could be predicted with a sensitivity of 98.1% and 92.9% and a specificity of 94.1% and 98.4%, respectively (accuracy, 96.8% and 97.4%). The mean κ value for interobserver agreement for the prediction of histopathological diagnosis was .843, whereas the intraobserver agreement showed a mean κ value of .892. Conclusions: Fluorescence-aided endomicroscopy of Barrett’s esophagus allows in vivo histology of the mucosal layer during ongoing endoscopy. Gastric and Barrett’s epithelium and Barrett’s-associated neoplastic changes can be diagnosed with high accuracy. Thus, endomicroscopy may be helpful in the management of patients with Barrett’s esophagus.

Section snippets

Confocal Laser Endoscope

The components of the confocal laser endoscope are based on the integration of a confocal laser microscope in the distal tip of a conventional video endoscope (joint venture between Pentax, Tokyo, Japan, and Optiscan, Victoria, Australia), which enables confocal microscopy in addition to standard video endoscopy. The diameter of the distal tip and the insertion tube was 12.8 mm. The distal tip contained an air and water jet nozzle, 2 light guides, an auxiliary water jet channel (used for

Results

A total of 75 consecutive patients were screened for possible inclusion in the present study, 12 of whom were excluded. A total of 63 patients fulfilled all inclusion criteria and were enrolled in this study, which was conducted between January 2004 and March 2005. All patients completed the study protocol (44 men, 19 women; age, 58.7 ± 16.3 y) including upper endoscopy plus confocal laser endomicroscopy (Figure 1). Indications consisted of long-lasting reflux symptoms (20 patients),

Discussion

In vivo confocal laser endomicroscopy is a newly developed tool that enables subsurface imaging of living cells in the mucosa during ongoing endoscopy. It offers the possibility to combine video endoscopy and confocal endomicroscopy.13 In the present article, we report about the use of this confocal laser endoscope in human beings to facilitate detection of Barrett’s epithelium and Barrett’s-associated neoplasia.

Modern endoscopy recently has seen many major technical improvements including the

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R.K. and L.G. contributed equally to this paper.

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