ABSTRACT
Objective To investigate the value of fluorescin-aided confocal laser endomicroscopy (CLE) for diagnosis of helicobacter pylori (Hp) infection. Methods From June 2009 to November 2009, patients undergone gastric endoscope examination with upper gastrointestinal symptoms (upper abdominal discomfort, abdominal distension, satiation, acid reflux and eructation) or screened for gastric cancer were enrolled. The gastric mucosa CLE image data of twenty diagnosed Hp positive patients and 10 Hp negative patients was analyzed retrospectively. By comparing with histological image of targeted biopsy tissue, the CLE diagnostic criteria for Hp infection were established. In the prospective study, CLE diagnose result was compared with Hp tested result. The consistency of CLE diagnostic criteria in different observers was also analyzed. The CLE image data with histopathology result were compared accordingly. Results Total 72 patients were enrolled in the prospective study,of 34 Hp positive patients, 31 patients were correctly diagnosed by CLE. The accuracy, sensitivity and specificity of CLE diagnosis were 88.9%, 91.2 and 86.8% respectively. CLE image displaying fluorescin leakage and cell shedding was the highest specificity for Hp infection diagnosis, (97.4 %);fluorescin leakage plus gastric pits distortion and cell edema was the highest sensitivity (88. 2%). The consistency of CLE diagnostic criteria in different observers was high (Kappa value 0. 72, 0.87). The CLE image of Hp infection was highly correlated with inflammation activity (P＜0. 001). Conclusion CLE can accurately distinguish normal mucosa from Hp infected mucosa at the cellular level. The diagnostic value for Hp infection was reliable.
ABSTRACT
Objective To estimate the value of confocal laser endomicroscopy (CLE)for differential diagnosis of gastric ulcer. Methods Patients diagnosed as gastric ulcer by conventional endoscopic mode of CLE were enrolled. The eonfocal endoscopic mode of CLE was used to observe the borderline and/or the surface of the ulcers. Biopsy specimen was taken for histopathological examination and the result of CLE was compared with histopathological finding. Results A total of 12 769 CLE images were obtained from 150 sites of 43 patients. The sensitivity and specificity of CLE for phlegmonosis process were 83.54% and 85.92%, respectively, with positive predictive value of 86.84% and negative predictive value of 82.43%. Whereas the sensitivity and specificity of CLE for intraepithelial neoplasia were 53.57% and 88.52%, respectively, with positive predictive value of 51.72% and negative predictive value of 89.26%. As for diagnosis of gastric cancer, the sensitivity and specificity of CLE were 88.37% and 93.46%, respectively, with positive predictive value of 84.44 % and negative predictive value of 95.24%. The kappa values for agreement of histopathological findings and CLE for diagnosis of phlegmonosis process, intraepithelial neoplasia and gastric cancer were 0.69,0.42 and 0.81, respectively. Conclusions CLE can provide a real-time histopathological diagnosis of the gastrointestinal tract with high sensitivity, specificity, positive and negative predictive values. Targeted biopsy can be done under CLE and the detective rates of precancerous lesions and tumors will be increased.
ABSTRACT
Objective To assess the value of confocal laser endomieroscopy (CLE) in diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Methods CLE examination was performed in 41 patients who needed further examination because of lesions in esophagus during July 2008 to April 2009. The diagnosis was made based on the features of esophageal squamous cells which was defined as low grade intraepithelial neoplasia(LGIN), high grade intraepithelial neoplasia (HGIN) and early esophageal squamous cell carcinoma (EC). Biopsy specimens were taken precisely matched to the CLE imaging sites. The result was compared with that of histopathology. Results There were 7281 eonfocal images obtained from 60 target lesions in 41 patients. The sensitivity, specificity and accuracy of CLE were 75.0%, 88.6% and 85.0% in diagnosis of LGIN, respectively, 85.7% ,92.3% and 90.0% in diagnosis of HGIN, respectively,and 88.9% ,96.1% and 95.0%, in diagnosis of EC,respectively. Conclusions It is an effective method for diagnosis of esophageal neoplastic lesions using CLE, which has high accuracy in diagnosis of HGIN and early esophageal cancer.
ABSTRACT
Y0, then the diagnosis of hypertension with liver cirrhosis obtained. The positive rate of diagnosis is 95% and the specificity is 96% and 91% respectively, much better than those in type B ultrasonography or gastric endoscopy, 78% or 75% respectively (P