ABSTRACT
Introduction: Radiofrequency ablation (RFA) of Barrett’s esophagus (BE) is associated with a high rate of complete eradication and a reduced risk of disease progression. Nevertheless, recent data indicate that about one third of patients had disease recurrence after reaching complete remission. Aim: To evaluate whether probe-based confocal laser endomicroscopy (pCLE) can determine complete eradication of BE as compared to histopathology from biopsy after complete RFA for optimized diagnosis in real-time and guide subsequent therapy. Materials and Methods: Consecutive patients undergoing RFA for treatment of BE were prospectively included. pCLE was performed after complete eradication (CE) of dysplasia (CE-D) or intestinal metaplasia (CE-IM) was reached. CE was defined as complete eradication of BE as documented by histopathology obtained from mucosal biopsies. Residual BE was defined as the presence of intestinal metaplasia or dysplasia in standard surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. Results: Based on histopathological analysis 33% of patients (3/9) had high-grade dysplasia, and 67% (6/9) had low-grade dysplasia. RFA was successfully performed in all patients (median age 60±10 yrs.). Three (33%) patients underwent endoscopic mucosal resection (EMR) followed by RFA. Patients received a median of 3±0.6 treatment sessions of RFA after which EGD with biopsies and pCLE were performed. pCLE documented CE-D and CE-IM in 78% and 44% of patients, while histology did in 90% and 67% respectively. Overall sensitivity, specificity, and accuracy of pCLE for real time diagnosis of residual BE after completed RFA treatment was 80% (95% CI 0.43–0.98), 75% (95% CI 0.28–0.98), and 78% (95% CI 0.36–0.98), respectively. Positive and negative predictive values were 80% (95% CI 0.42–0.98) and 75% (95% CI 0.28–0.98). Conclusion: pCLE is yet not reliable for In vivo diagnosis of residual BE after complete RFA in real time. Larger, prospective studies are now highly warranted to further proof this initial concept.
ABSTRACT
Introducción: la endoscopía de doble balón (EDB) es un nuevo método endoscópico para examinar el intestino delgado. Objetivo: evaluar el rendimiento diagnóstico y terapéutico de la EDB. Pacientes y métodos: todos los pacientes que fueron evaluados por sospecha de patología del intestino delgado durante un período de 2 1/2 años en un estudio de cohorte prospectivo unicéntrico. A todos los pacientes se les realizó al menos una EGD y una colonoscopía previa. Todos los pacientes recibieron preparación del intestino delgado el día previo al procedimiento usando preparación estándar de colon. Resultados: se realizaron 225 EDB en 178 pacientes (95 hombres, 83 mujeres; edad mediana 59 años, rango 12-93); vía oral (n=160), vía anal (n=65). Las indicaciones de EDB incluyeron (una o más indicaciones por paciente): sangrado gastrointestinal de origen oscuro (n=83), sospecha o evaluación de pacientes con enfermedad de Crohn (n=35), diarrea, malabsorción o sospecha de enfermedad celíaca (n=11), búsqueda y remoción de pólipos en pacientes con síndrome de Peutz-Jehgers o síndrome de poliposis adenomatosa familiar (n=23), búsqueda de tumor primario o seguimiento (n=14), dolor abdominal(n=6) y misceláneas (isquemia, engrosamiento de pliegues en estudios radiológicos, etc); (n=6). La duración media del procedimiento fue de 50 minutos (rango 20- 150 min). La exposición media a radiación fue 206 d Gy/cm2 (rango 0-1492). La inserción media en intestino delgado fue de 180 cm, con un rango de 5 cm a a totalidad del intestino delgado (650 cm, rango 20 cm a 650 cm), inserción media por vía oral fue de 240 cm, y por vía anal 65 cm (rango 10 cm a 150 cm). Un nuevo diagnóstico fue realizado o confirmado en 108 de 178 pacientes (60%). Los hallazgos incluyeron: angiodisplasias, ulceraciones, yeyunopatía por hipertensión portal, estenosis, pólipos (incluyendo hamartomas en pacientes con síndrome de Peutz-Jeghers y lipoma), yeyunitis isquémica y normal. DBE resultó en una intervención...
Introduction: Double balloon enteroscopy (DBE) is a new endoscopic method for the examination of the small intestine. Objective: To determine the diagnostic yield and therapeutic utility of DBE. Patients and methods: All patients undergoing DBE using a Fujinon intestinoscope for suspected small bowel diseases during a 2 1/2 year period were studied in a prospective single-center cohort study. All patients underwent rior EGD and colonoscopy. Patients underwent small bowel cleansing on the day before the procedure using a standard colon lavage solution. Results: 225 DBE in 178 patients, (95 males, 83 females; mean age 59 years-old, range 12-93); oral route (n=160), anal (n=65). Indications (one or more per patient): GI bleeding (n=83), suspected Crohns disease or evaluation of small bowel involvement or complications (n=35), diarrhea or malabsorption or suspected celiac disease (n=11), polyp removal in Peutz-Jeghers syndrome or familial polyposis (n=23), tumor surveillance or search of primary tumor (n=14), abdominal pain (n=6) and miscellaneous (n=6). Mean duration of the procedure was 50 min, range 20 min to 150 min. Mean radiation exposure: 206 d Gy/cm2 (range 0-1492). The overall mean depth of small bowel insertion was 180 cm, ranging from 5 cm to the entire small bowel (650 cm). The mean depth of insertion via the oral route was 240 cm (range 20 cm to 650 cm) and via the anal route it was 65 cm (range 10 cm a 150 cm). A new diagnosis was reached in 108/178 patients (60%). Findings included: angiodysplasia, ulcerations, stenosis, polyps, portal jejunopathy, ischemic jejunitis and normal. DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfusions) in 64% (115/178) of the patients. Conclusions: DBE was clinically useful for reaching a new diagnosis and to start new therapies, change existing therapies, and perform an operative intervention or to provide therapeutic endoscopy in...