The Preliminary Study Of The Diagnosis Of Barrett's Esophagus With Confocal Endomicroscopy

Barrett's esophagus is a metaplastic congdition of the esophagus where the squamous epithelium lining the lower esophagus is replaced by a columnar, gastric type epithelium. BE is the only precancerous diease of esophageal adenocarcinomas generally. In order to observe the change of BE, the patients of BE should be examined regularly. The diagnosis of BE is dependent on the biopsy with gastroscope. As we can't observe esophageal cells in the conventional endoscopic view, the biopsies are usually not accurately. Confocal laser endomicroscope is the fusion of endoscope and confocal microscope. With confocal laser endomicroscope we can observe a detailed view inside life. The confocal laser endomicroscope provides full resolution laser scans comparable to conventional histology viewing capabilities of cellular features and sub-cellular features to a depth of 250 microns. Confocal laser endomicroscopy can apply realtime tissue diagnoses.This clinical study is to evaluate the application of confocal laser endomicroscopy for diagnosis of Barrett's esophagus.Methods1. Patients:Consecutive 23 patients who were suspected to have Barrett's esophagus by conventional endoscopy in the centre of endoscopy Shengjing hospital of China medical university from June 2006 to March 2007 were recruited. There were 14 male and 9 female patients with median age of 48 years old (from 26 to 77 years old).2. Materials:PANTAXISC-1000,EC-3870CIFK, Japan 10% fluorescein sodium, Guangzhou3. Methods:The patients underwent examinations of lower esophagus at four quadrant every 2 cm with flourescein-aided confocal endomicroscopy. Images obtained from above sites were stored digitally and targeted biopsies were obtained at the same location.4. ssessment:The results of confocal endomicroscopic images and pathological samples were compared. The results of pathology are the gold standard.5.Statistical analysis:Sensitivity, specificity, accuracy, positive and negative predictive value, positive and negative likelihood ratio were performed by SAS software version 6.12.ResultsSquamous epithelium, columnar epithelium and goblet cells can be distinguished in the confocal endomicroscopic view. A totle of 86 sites in 23 cases were examined with confocal enomicroscopy. 39 sites in 16 cases diagnosed as Barrett's epithelia by confocal endomicroscopy. 36 samples were histologically diagnosed as Barrett's epithelia in 16 cases. BE could be diagnosed by confocal endomicroscopy with a sensitivity of 97.22%, a specificity of 92.00%, a accuracy of 94.19%,positive predictive value of 89.74%, negative value of 97.87%, positive likelihood ratio of 12.15, negative likelihood ratio of 0.03.ConclusionThe targeted biopsy can be done during the confocal endomicroscopy examination. The confocal endomicroscopy can diagnoses Barrett's esophagus with high sensitivity and specificity, and offers an new powerful tool in the management of BE.