Journal Mobile Options
Table of Contents
Vol. 6, No. 2, 2012
Issue release date: May – August
Section title: Published: May 2012
Open Access Gateway
Case Rep Gastroenterol 2012;6:285–292
(DOI:10.1159/000338835)

Probe-Based Confocal Laser Endomicroscopy to Guide Real-Time Endoscopic Therapy in Barrett’s Esophagus with Dysplasia

Johnson E.A.a · De Lee R.a · Agni R.b · Pfau P.a · Reichelderfer M.a · Gopal D.V.a
aDivision of Gastroenterology and Hepatology and bDepartment of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc., USA
email Corresponding Author

Abstract

Probe-based confocal laser endomicroscopy (pCLE) is a novel imaging technique which utilizes a low-power laser light passed through a fiber-optic bundle, within a miniprobe that is advanced into the working channel, to obtain microscopic images of the mucosa. This allows the endoscopist to evaluate the microarchitecture of the gastrointestinal epithelium in real time. At this time pCLE cannot replace histopathology, but it can provide diagnostic information as well as guide therapeutic management in patients with Barrett’s esophagus (BE) with high-grade dysplasia (HGD). We describe a retrospective case series in which four patients with BE and biopsy-proven HGD underwent endoscopy with pCLE to direct real-time endoscopic ablation therapy and/or endoscopic mucosal resection (EMR), which was performed in conjunction with pCLE. All four patients had pCLE showing features of HGD. After either EMR or radiofrequency ablation (RFA), pCLE was again used to evaluate the margins after therapy to assure accuracy. In one case, pCLE had features of dysplasia at the margin and further repeat EMR was immediately performed. Another case had a normal-appearing esophagus, but pCLE found features of BE in discrete areas and targeted biopsies were performed, which confirmed BE. This patient subsequently underwent RFA therapy of the residual areas of BE. In conclusion, in patients with BE and dysplasia, pCLE is an effective tool used to target biopsies, guide endoscopic therapy and assess the accuracy of EMR or RFA.

© 2012 S. Karger AG, Basel


  

Key Words

  • Barrett’s esophagus
  • Probe-based confocal laser
  • Endomicroscopy
  • High-grade dysplasia
  • Low-grade dysplasia

  

Author Contacts

Deepak V. Gopal, MD, FRCP(C), FASGE
Division of Gastroenterology and Hepatology
School of Medicine and Public Health, University of Wisconsin, 4223 MFCB
1685 Highland Avenue, Madison, WI 53705 (USA)
Tel. +1 608 263 4033, E-Mail dvg@medicine.wisc.edu

  

Article Information

Published online: May 23, 2012
Number of Print Pages : 8
Number of Figures : 1, Number of Tables : 2,

  

Publication Details

Case Reports in Gastroenterology

Vol. 6, No. 2, Year 2012 (Cover Date: May - August)

Journal Editor: Urrutia R. (Rochester, Minn.), Lomberk G. (Rochester, Minn.)
ISSN: 1662-0631 (Print), eISSN: 1662-0631 (Online)

For additional information: http://www.karger.com/CRG


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Probe-based confocal laser endomicroscopy (pCLE) is a novel imaging technique which utilizes a low-power laser light passed through a fiber-optic bundle, within a miniprobe that is advanced into the working channel, to obtain microscopic images of the mucosa. This allows the endoscopist to evaluate the microarchitecture of the gastrointestinal epithelium in real time. At this time pCLE cannot replace histopathology, but it can provide diagnostic information as well as guide therapeutic management in patients with Barrett’s esophagus (BE) with high-grade dysplasia (HGD). We describe a retrospective case series in which four patients with BE and biopsy-proven HGD underwent endoscopy with pCLE to direct real-time endoscopic ablation therapy and/or endoscopic mucosal resection (EMR), which was performed in conjunction with pCLE. All four patients had pCLE showing features of HGD. After either EMR or radiofrequency ablation (RFA), pCLE was again used to evaluate the margins after therapy to assure accuracy. In one case, pCLE had features of dysplasia at the margin and further repeat EMR was immediately performed. Another case had a normal-appearing esophagus, but pCLE found features of BE in discrete areas and targeted biopsies were performed, which confirmed BE. This patient subsequently underwent RFA therapy of the residual areas of BE. In conclusion, in patients with BE and dysplasia, pCLE is an effective tool used to target biopsies, guide endoscopic therapy and assess the accuracy of EMR or RFA.

© 2012 S. Karger AG, Basel


  

Author Contacts

Deepak V. Gopal, MD, FRCP(C), FASGE
Division of Gastroenterology and Hepatology
School of Medicine and Public Health, University of Wisconsin, 4223 MFCB
1685 Highland Avenue, Madison, WI 53705 (USA)
Tel. +1 608 263 4033, E-Mail dvg@medicine.wisc.edu

  

Article Information

Published online: May 23, 2012
Number of Print Pages : 8
Number of Figures : 1, Number of Tables : 2,

  

Publication Details

Case Reports in Gastroenterology

Vol. 6, No. 2, Year 2012 (Cover Date: May - August)

Journal Editor: Urrutia R. (Rochester, Minn.), Lomberk G. (Rochester, Minn.)
ISSN: 1662-0631 (Print), eISSN: 1662-0631 (Online)

For additional information: http://www.karger.com/CRG


Article / Publication Details

First-Page Preview
Abstract of Published: May 2012

Published online: 5/23/2012
Issue release date: May – August

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 2

ISSN: (Print)
eISSN: 1662-0631 (Online)

For additional information: http://www.karger.com/CRG


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.