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Published: May 2012

Open Access Gateway

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

Author affiliations

aDivision of Gastroenterology and Hepatology and bDepartment of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc., USA

Corresponding Author

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

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Case Rep Gastroenterol 2012;6:285–292

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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

Article / Publication Details

First-Page Preview
Abstract of Published: May 2012

Published online: May 23, 2012
Issue release date: May – August

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

eISSN: 1662-0631 (Online)

For additional information: https://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 government 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.
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