Diagnostic value of confocal laser endoscopy in ulcerative diseases of the stomach

AIM: To assess the clinical value of confocal laser endoscopy (CLE) in diagnosing ulcerative diseases of the stomach.

METHODS: Forty-two patients with ulcerative lesions in the stomach suspected to be malignant by conventional endoscopy were enrolled in this study and underwent CLE. Fluorescein sodium (5.5 mL of 10% solution) was administered intravenously to enable fluorescent staining of the mucosa of the stomach. Images were acquired from the lesioned areas. Targeting biopsies were performed under the guide of CLE. The detection rate of malignant ulcers was compared between histopathologic diagnosis of postoperative specimens and biopsy targeting specimens.

RESULTS: CLE diagnosed malignant ulcers in 38 patients. Histopathology of biopsy targeting specimens and postoperative specimens detected malignant ulcers in 35 and 40 patients, respectively. The detection rate of malignant ulcers by CLE was 95%, and that by histopathology of biopsy targeting specimens was 87.5%. There was no significant difference in the detection rate of malignant ulcers between histopathology of biopsy targeting specimens and postoperative specimens (P > 0.05).

CONCLUSION: CLE enables real-time histopathologic imaging of gastric mucosa in vivo at the time of endoscopic examination. Compared with conventional endoscopy, biopsy targeting can improve the detection rate of diseases and decrease missed diagnosis. CLE has significant value in diagnosing ulcerative diseases of the stomach.

High technology imaging in digestive endoscopy

A thorough endoscopic visualization of the digestive mucosa is essential for reaching an accurate diagnosis and to treat the different lesions. Standard white light endoscopes permit a good mucosa examination but, nowadays, the introduction of powerful endoscopic instrumentations increased ability to analyze the finest details. By applying dyes and zoom-magnification endoscopy further architectural detail of the mucosa can be elucidated. New computed virtual chromoendoscopy have further enhanced optical capabilities for the evaluation of submucosal vascolar pattern. Recently, confocal endomicroscopy and endocytoscopy were proposed for the study of ultrastructural mucosa details. Because of the technological contents of powerful instrumentation, a good knowledge of implemented technologies is mandatory for the endoscopist, nowadays. Nevertheless, there is a big confusion about this topic. We will try to explain these technologies and to clarify this terminology.

Endoscopic imaging: How far are we from real-time histology?

Currently, in gastrointestinal endoscopy there is increasing interest in high resolution endoscopic technologies that can complement high-definition white light endoscopy by providing real-time subcellular imaging of the epithelial surface. These ‘optical biopsy’ technologies offer the potential to improve diagnostic accuracy and yield, while facilitating real-time decision-making. Although many endoscopic techniques have preliminarily shown high accuracy rates, these technologies are still evolving. This review will provide an overview of the most promising high-resolution imaging technologies, including high resolution microendoscopy, optical coherence tomography, endocytoscopy and confocal laser endoscopy. This review will also discuss the application and current limitations of these technologies for the early detection of neoplasia in Barrett’s esophagus, ulcerative colitis and colorectal cancer.

Advances in the diagnosis of Barrett's esophagus

Barrett's esophagus is a metaplastic change in esophageal lining, characterized by the replacement of normal squamous epithelium with columnar epithelium. Barrett's esophagus is associated with a high risk of esophageal adenocarcinoma. As the incidence of esophageal adenocarcinoma has risen dramatically in developed countries, the research on Barrett's esophagus is attracting increasing attention. In this article, we will review the recent advances in the diagnosis of Barrett's esophagus.

Diagnostic value of confocal laser endoscopy in digestive system diseases

Confocal laser endoscopy is a novel technology which allows subsurface histological diagnosis at a cellular and subcellular level in vivo during ongoing endoscopy. Confocal laser endoscopy thereby provides instantaneous histopathology photographs during ongoing upper, lower gastrointestinal tract endoscopy and laparoscopy in high resolution by point scanning laser fluorescence analysis. The author undertook a systematic review that included novel technology advancement of confocal laser endoscopy, confocal laser laparoscopy, diagnostic values on the Barrett's esophagus, esophageal adenocarcinoma and gastric cancer, H. pylori infection, collagenous colitis, ulcerative colitis, intraepithelial neoplasia, colorectal cancer and chronic hepatic lesions in diseases pertaining to digestive system. In addition, this article described molecular imaging of cancer, functional imaging of altered perfusion in malignant tumor and inflammatory diseases and high resolution in vivo morphological diagnosis. These new advanced technologies indicate that confocal laser endoscopy is evolving as a novel technique for rapid diagnosis of gastrointestinal neoplastic diseases at the microscopic level and bears the potential for molecular imaging in humans in the near future.