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Abstract Introduction: Confocal laser endomicroscopy is an optical imaging technique that allows in vivo, real-time, microscope-like images of the upper aerodigestive tract's mucosa. The assessment of morphological tissue characteristics for the correct differentiation between healthy and malignant suspected mucosa requires strict evaluation criteria. Objective: This study aims to validate an eight-point score for the correct assessment of malignancy. Methods: We performed confocal laser endomicroscopy between March and October 2020 in 13 patients. 197 sequences (11.820 images) originated from the marginal area of pharyngeal and laryngeal carcinomas. Specimens were taken at corresponding locations and analyzed in H&E staining as a standard of reference. A total of six examiners evaluated the sequences based on a scoring system; they were blinded to the histopathological examination. The primary endpoints are sensitivity, specificity, and accuracy. Secondary endpoints are interrater reliability and receiver operator characteristics. Results: Healthy mucosa showed epithelium with uniform size and shape with distinct cytoplasmic membranes and regular vessel architecture. Confocal laser endomicroscopy of malignant cells demonstrated a disorganized arrangement of variable cellular morphology. We calculated an accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 83.2%, 81.3%, 85.5%, 86.7%, and 79.7%, respectively, with a κ-value of 0.64, and an area under the curve of 0.86. Conclusion: The results confirm that this scoring system is applicable in the laryngeal and pharyngeal mucosa to classify benign and malignant tissue. A scoring system based on defined and reproducible characteristics can help translate this experimental method to broad clinical practice in head and neck diagnosis.
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Abstract Introduction Probe-based confocal laser endomicroscopy (p-CLE) is a method for real-time in vivo visualization of mucosal changes on a cellular level. Due to the size of the endoscopes, it was mainly used in the gastrointestinal tract so far. First investigations on head and neck carcinoma described the oropharyngeal application. The further miniaturization of the laser probe now allows endonasal application and, thus, first experiences with the investigation of endonasal neoplasms. Objectives The aim of the present investigation is to elucidate, based on the morphological criteria validated in the oropharynx, whether these criteria be transferred in a similar way to the endonasal mucosa. Methods We conducted p-CLE (Cellvizio, Paris, France) with intravenous fluorescein staining in endoscopic sinus surgery in a patient with sinonasal inverted papilloma and a histologically confirmed squamous cell carcinoma. We compared the cellular visualization of pathological changes with those of healthy mucosa in the same specimen, and also with our former findings in the oropharynx. Results Endonasal p-CLE proved to be quite feasible in the surgical setting, and the transfer of malignancy criteria in analogy to histological examination could be optically retraced. Furthermore, additional criteria for tissue dignity assessment were obtained. Conclusion Our results suggest that endonasal application of p-CLE represents a valuable extension of the diagnostic repertoire available to date by an additional realtime analysis of the nasal mucosa. This is of particular value in surgically challenging anatomical areas such as the paranasal sinuses.
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BACKGROUND/AIMS: This study aimed to evaluate the diagnostic accuracy of dual-focus narrow-band imaging (dNBI) and Lugol'schromoendoscopy (LCE) combined with probe-based confocal laser endomicroscopy (pCLE) to screen for esophageal squamous cell neoplasms (ESCNs) in patients with a history of head and neck cancer. METHODS: From March to August 2016, dNBI was performed. Next, LCE was performed, followed by pCLE and biopsy. Histology has historically been the gold standard to diagnose ESCN. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI and LCE adjunct with pCLE were determined. RESULTS: Twenty-four patients were included. Ten ESCNs were found in 8 patients (33%). Forty percent of high-graded intraepithelial neoplasias and all low-grade intraepithelial neoplasias were overlooked by dNBI. The sensitivity, specificity, PPV, NPV, and accuracy of dNBI vs. LCE combined with pCLE were 50% vs. 80%, 62% vs. 67%, 36% vs. 44%, 75% vs. 91%, and 83% vs. 70%, respectively. CONCLUSIONS: The use of dNBI to detect ESCN was suboptimal. LCE with pCLE following dNBI had additional value for detecting esophageal dysplasia not detected by dNBI. The use of pCLE to detect dNBI-missed lesions yielded a high NPV, while pCLE-guided biopsy could reduce the number of unnecessary biopsies.
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Humans , Biopsy , Epithelial Cells , Head and Neck Neoplasms , Neoplasms, Squamous Cell , Sensitivity and SpecificityABSTRACT
Objective:To investigate the relationship between expression of programmed cell death 1 ligand 2 (PD-L2) in colorectal cancer and prognosis, and explore the feasibility of application of PD-L2 in confocal laser endomicroscopy in the diagnosis of colorectal cancer. Methods:Immunohistochemistry was used to detect the expression of PD-L2 in 100 patients with colorectal cancer. The relationship between the expression levels and the prognosis of patients was analyzed. The expressions of PD-L2 in 30 cases of early colorectal cancer and adjacent normal mucosa were detected by immunohistochemistry and Western blotting. Confocal laser endomicroscopy was used to observe the difference in fluorescence intensity between early colorectal cancer and adjacent normal mucosa after being incubated with PD-L2 fluorescent antibody. Results:There were statistically significant differences in T-stage and distant metastasis between the patients with low and high expression of PD-L2, and they were both positively correlated with expression of PD-L2 (r=0.274, P=0.009; r=0.216, P=0.039). There was also a positive correlation between PD-L2 membrane expression and T stage (r=0.201, P=0.037). Survival analysis showed that the survival rate of patients with high PD-L2 expression was significantly lower than that of patients with low PD-L2 expression (P=0.000). The protein expression of PD-L2 in early colorectal cancer was significantly higher than that in adjacent normal mucosa. Under confocal laser endomicroscopy, the fluorescence intensity of early colorectal cancer was higher than that of adjacent normal mucosa. Conclusion:High expression of PD-L2 in colorectal cancer predicts poor prognosis in patients. Application of PD-L2 in confocal laser endomicroscopy may contribute to the diagnosis of colorectal cancer.
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Objective To evaluate the feasibility of needle-based confocal laser endomicroscopy (nCLE) for imaging of intra-abdominal tissues and organs in rabbit models in vivo. Methods The nCLE miniprobe was inserted through the 19-gauge needle into various intra-abdominal tissues and organs[omentum majus, liver, pancreas and psoas major (skeletal muscle)]. The nCLE images were acquired and real-time sequences of respective locations were recorded. Finally, nCLE image characteristics were compared with histopathologic findings. Results nCLE was successfully performed in intra-abdominal tissues and organs of five rabbit models. The microscopic structures of cells, glands and microvessels in the omentum majus, liver, pancreas and psoas major ( skeletal muscle) were visualized clearly, respectively. Characteristics of various intra-abdominal tissues and organs were displayed on nCLE images, which were correlated well with histological findings. Conclusion Imaging of intra-abdominal tissues and organs with nCLE in vivo is feasible in future clinical practice.
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Objective To evaluate the advantages of confocal laser endomicroscopy(CLE)for function repairing of ulcerative colitis(UC). Methods Thirty patients with UC who were diagnosed and treated in the First Affiliated Hospital of Zhejiang University Medical College between July 2014 and December 2016 were enrolled in the study group. The control group consisted of 10 patients who were diagnosed as having colonic polyps with colonoscopy and underwent polypectomy in the same period. Both groups were examined with white light endoscopy and CLE,then the fluorescein leakage score was compared. Results There were 10 out of 30 cases in the study group whose whole intestinal mucosa were judged as normal under white light endoscopy. In the other 20 cases,there were parts of intestinal mucosa being judged as abnormal. All of the 10 cases in the control group were with normal colon mucosa. There was a significant difference on fluorescein leakage score by CLE between the study group which showed normal by white light endoscopy and the control group(P<0.05). The fluorescein leakage score by CLE was significant difference between the abnormal intestinal segment and normal intestinal segment in 20 patients with active UC(P<0.05). Spearman correlation analysis showed that there was non-ranked correlation between the fluorescein leakage score of CLE and histopathological findings of biopsy in UC patients with normal mucosa of the left colon under white light endoscopy(rs=0.394,P>0.05). Conclusion In the process of mucosal healing of UC patients,structural repair can be found firstly through CLE. Mucosal healing under white light endoscopy cannot represent the functional recovery. CLE is more effective than the histopathology in the evaluation of mucosal barrier function.
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Objective To perform an exploratory investigation on confocal laser endomicroscopy (CLE) in the diagnosis of malignant bladder tumour.Methods From June 10 to July 11,2017,6 male bladder cancer patients underwent white light cystoscopy (WLC) + CLE examination,aging 64-86 years (median 72 years).All patients received TURBT on suspected lesions.WLC and CLE imaging results were recorded and validated by pathologic specimens.Results Lesions confirmed by histopathology were 3 low grade non-invasive papillary urothelial carcinomas,1 high grade non-invasive papillary urothelial carcinoma,1 low grade invasive urothelial carcinoma,1 high grade invasive urothelial carcinoma,1 carcinoma in situ (CIS),1 high grade dysplasia,1 cystitis glandularis,1 chronic inflammation,and 1 scar tissue.For CLE images in the normal urothelium,three layers of cells with different presentation were observed,namely,the superficial umbrella cells,the intermediate cells smaller in size and uniformly shaped,and the capillary network in the lamina propria.For non-invasive urothelial carcinoma,tumour cells appeared as papillary lesions growing from fibrovascular cores,with low grade cells appearing monomorphic and more cohesively arranged,and high grade cells relatively pleomorphic,more disorganised and with tortuous blood vessels in the fibrovascular core.For invasive urothelial carcinoma,tumour cells invaded the lamina propria,with uniform appearances,poor cohesion and indistinct cellular borders,and high grade ones were more pleomorphic.CIS and inflammation both appeared as erythematous patch-like flat lesions under WLC and sometimes difficult to differentiate.Under CLE,the former appeared as dysplastic and disorganised cells with indistinct cellular borders,with intact lamina propria,and inflammatory cells were discovered as infiltrative clusters in the lamina propria that were uniformly shaped and loosely connected.Dysplasia appeared somewhat similar compared with CIS under WLC,but with lower cellular irregularity as confirmed with pathology.Cellular appearance and structure in scar tissue was similar to that in the normal urothelium,but superficial umbrella cells were more likely absent,with thinner cell layers,and inflammatory infiltration was sometimes discovered in the lamina propria.Conclusions CLE provides real-time cellular imaging of the urothelium,and shows promising potential for clinical diagnosis,especially in differentiating fiat urothelial lesions.Large prospective studies are required for further validation.
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Objective To discuss the feasibility and application value of probe-based confocal laser endomicroscopy(pCLE)for differential diagnosis of maligant biliary stricture. Methods The pCLE images of 10 patients with definite biliary structure were retrospectively analyzed to establish pCLE classification of biliary lesions, and then the patients, who accepted pCLE examination and traditional brush cytology successively,were selected for further prospective research. Each patient was scored in terms of sign of malignant lesion to analyze diagnostic efficacy of combinations of different signs using classification standard of pCLE image. The results were compared with cell brushing test. The diagnostic consistency of observers using pCLE was also evaluated. Results A total of 25 patients completed the prospective research. When patients presented with any two or more malignant signs,diagnostic efficacy of pCLE was best with accuracy rate of 84.0%(95%CI:64.7%-94.2%),and sensitivity,specificity,positive predictive value and negative predictive value was 87.5%(95% CI: 62.7%-97.8%), 77.8%(95% CI: 44.3%-94.7%), 87.5% (95%CI: 62.7%-97.8%), and 77.8%(95% CI: 44.3%-94.7%), respectively. The corresponding indicators of brush cytology was 56.0%(95% CI: 37.1%-73.4%), 31.3%(95% CI: 13.9%-55.9%), 100.0%(95%CI:65.5%-100.0%),100.0%(95%CI:51.1%-100.0%),and 45.0%(95%CI:25.8%-65.8%),respectively,and the sensitivity(P=0.001)and accuracy(P=0.03)were significantly lower than that of pCLE. The κ value of interobserver agreement level was 0.73, which revealed a significant consistency. Conclusion pCLE provides a new approach for the differential diagnosis of biliary stricture, and shows a potential clinical application value.
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Objective To discuss the application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy ( EUS-nCLE) in the diagnosis of pancreatic neoplasms. Methods Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasonography and punctured by 19 G needle, and then the confocal microprobe was implanted through the needle. The lesions nature was estimated according to obtained images. The diagnostic yield and complication was evaluated and compared with pathology. Results A total of 28 patients successfully underwent EUS-nCLE, and high quality images were obtained in all patients. The final diagnosis were 5 cases of serous cystadenoma ( SCN ) , 3 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous neoplasms ( IPMN) , 1 case of pseudocyst, 10 cases of ductal adenocarcinoma, 1 case of neuroendocrine tumor, 2 cases of solid pseudopapillary tumor, 2 cases of chronic pancreatitis, and 1 cases of lymphoma. The diagnostic yield in 26 patients with pathology was 73. 1%(19/26) and the specificity of SCN and IPMN was 100%(7/7). The complications, mostly pancreatitis and intracystic hemorrhage, occurred in 10. 7% ( 3/28) patients. Conclusion EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms, and shows high specificity in SCN and IPMN.
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Objective To discuss the application of endoscopic ultrasound-guided needle-based confocal laser endomicroscopy ( EUS-nCLE) in the diagnosis of pancreatic neoplasms. Methods Patients with pancreatic neoplasms were diagnosed by endoscopic ultrasonography and punctured by 19 G needle, and then the confocal microprobe was implanted through the needle. The lesions nature was estimated according to obtained images. The diagnostic yield and complication was evaluated and compared with pathology. Results A total of 28 patients successfully underwent EUS-nCLE, and high quality images were obtained in all patients. The final diagnosis were 5 cases of serous cystadenoma ( SCN ) , 3 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous neoplasms ( IPMN) , 1 case of pseudocyst, 10 cases of ductal adenocarcinoma, 1 case of neuroendocrine tumor, 2 cases of solid pseudopapillary tumor, 2 cases of chronic pancreatitis, and 1 cases of lymphoma. The diagnostic yield in 26 patients with pathology was 73. 1%(19/26) and the specificity of SCN and IPMN was 100%(7/7). The complications, mostly pancreatitis and intracystic hemorrhage, occurred in 10. 7% ( 3/28) patients. Conclusion EUS-nCLE is a safe and feasible method in the diagnosis of pancreatic neoplasms, and shows high specificity in SCN and IPMN.
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AIM To investigate the tissue distribution of brucine-loaded solid lipid nanoparticles in mice in vivo.METHODS Mice were intravenously injected with suspension of prepared brucine-loaded solid lipid nanoparticles and marked by fluorescein isothiocyanate (FITC).The in vivo tissue distribution of nanoparticles was analyzed by having the brucine contents in various tissues (heart,liver,spleen,lung,kidney and bone) determined by HPLC,after which fluorescence confocal laser endomicroscopy was used for further detection.RESULTS Brucine had its the highest (1.64) relative intake efficiency (Re) in mice liver,and the nanoparticles shared all over one value of targeting efficiencies (Te) in various tissues,manifesting a much stronger selectivity to liver than that of brucine solution.With the extension of time,the FITC-narked nanoparticles displayed a rich extracellular to intracellular distribution indicating a positive correlation.CONCLUSION Brucine's increased distribution in the liver tissue of mice due to its solid lipid nanoparticle form shows obvious for liver targeting.
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Endoscopy plays a crucial role in the management of inflammatory bowel disease (IBD) in terms of diagnosis, monitoring of mucosal status, and surveillance of colitis-associated neoplasia. Mucosal healing evaluated by endoscopy has been recognized as the target of treatment in the era of powerful biologics therapy. The optimal modality for identifying dysplasia in IBD has yet to be well defined. Increasing progress has recently been made in endoscopic technologies to more accurately assess mucosal inflammation and more effectively detect dysplasia. Here we review the data of advanced endoscopic imaging techniques such as chromoendoscopy, virtual chromoendoscopy, endocytoscopy, and confocal laser endomicroscopy in the management of IBD.
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Biological Products , Diagnosis , Endoscopy , Inflammation , Inflammatory Bowel DiseasesABSTRACT
Objective To evaluate the accuracy of confocal laser endomicroscopy (CLE)in primary bile reflux gastritis (BRG).Methods From November 10th to December 15th,2015 ,55 patients underwent CLE examination and preliminarily diagnosed as BRG with traditional white-light endoscopy were enrolled.CLE score standard was designed.Dixon pathologic score was considered as gold standard. Receiver operating characteristic (ROC)curve was drawn to evaluate the accuracy of CLE score in BRG diagnosis.Sensitivity,specificity and 95 % confidence interval (CI )were calculated.Kappa analysis was performed to assess the inter-observer agreement of CLE score.Results According to Dixon pathologic score standard,29 patients (52.7%)were diagnosed as primary BRG among the 55 enrolled patients. Among the 42 Helicobacter pylori (H .pylori )negative patients,the area under receiver operating characteristic curve (AUC)of CLE in BRG diagnosis was 0.90 (95 %CI 0.81 —1 .00).Taking CLE score over six as the cut-off value for diagnosis,the sensitivity and specificity was 84.00% (95 %CI 65 .35 %—93.60%)and 82.35 % (95 %CI 58.97%—93.81 %),respectively.The Kappa value for inter-observer agreement in BRG diagnosis was 0.60 (95 %CI 0.24—0.95).Conclusion Primary BRG can be accurately diagnosed by CLE in H .pylori negative patients with high sensitivity and specificity.
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An accurate diagnosis of solid pancreatic lesions (SPLs) is important because pancreatic cancer cannot be ignored if curative treatment is possible. Prompt and reliable diagnostic procedures are greatly needed for patients presenting with SPLs, particularly where resection is possible for a malignant mass. Several endoscopic ultrasound (EUS)-related technologies including a novel EUS-guided needle-based confocal laser endomicroscopy (EUS-nCLE) can provide real-time images at the cellular level (1,000-fold magnification). A 19-gauge EUS-guided fine needle aspiration (EUS-FNA) needle is recommended because its channel is large enough for the 0.85-mm diameter nCLE miniprobe. The procedure is performed by standard EUS-FNA techniques with either pre- or post-loading technique. Ten percent fluorescein sodium (2.5–5 mL) is used as an enhancing agent and is intravenously injected immediately before puncturing the lesion. Only a few studies have used the technique and reported results. A recent study from 19 malignant and 3 benign SPLs classified EUS-nCLE findings according to 4 signs: dark clumps, and dilated vessels (predominantly seen in malignant SPLs) and fine white fibrous bands and normal acini (predominantly seen in benign SPLs). Using these criteria, researchers correctly diagnosed 18 of the malignant SPLs (94.7%). Another study described 2 lesions as having “dark cells aggregates with pseudo-glandular aspects, and straight hyperdense elements more or less thick corresponding to tumoral fibrosis” in 17 of 18 malignant SPLs. Thus far, no large and systematic study has been performed to evaluate the potential clinical use of EUS-nCLE for diagnosing SPLs. However, based on available information from a few studies and the current limitations of EUS-FNA, EUS-nCLE can potentially provide a complementary role in diagnosing such lesions. Nevertheless, more studies are certainly needed.
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Humans , Biopsy, Fine-Needle , Diagnosis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Fluorescein , Needles , Pancreatic Neoplasms , UltrasonographyABSTRACT
Endoscopy plays a significant role in the diagnosis, management, and surveillance of colorectal cancer (CRC) and inflammatory bowel diseases (IBDs). Moreover, magnifying endoscopy and image-enhanced endoscopy has a crucial role in the clinical setting. Recently, a super-magnifying endoscope has been developed, and two devices, confocal laser endomicroscopy (CLE) and an endocytoscopy system (ECS), which allow in vivo microscopic inspection of the microstructural mucosal features of the gastrointestinal tract, are currently available. Studies on the use of ECS in CRC were reported by a Japanese group. Additionally, a few studies on the use of ECS in IBD have been reported. CLE has been shown to be reliable in assessing the activity of the disease in IBDs in both ulcerative colitis and Crohn's disease. Various published studies evaluated the use of CLE during colonoscopy to distinguish colorectal polyp pathology and neoplasia. However, these studies are heterogeneous, and further evidence is necessary to confirm the efficacy of CLE.
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Humans , Asian People , Colitis, Ulcerative , Colonoscopy , Colorectal Neoplasms , Crohn Disease , Diagnosis , Endoscopes , Endoscopy , Gastrointestinal Tract , Inflammatory Bowel Diseases , Pathology , PolypsABSTRACT
La endomicroscopia confocal láser basada en probes (Cellvizio de Mauna Kea Technologies, París) es una nueva tecnología que permite, durante cualquier procedimiento endoscópico, realizar análisis histológicos en tiempo real (biopsia óptica), mejorando el diagnóstico y ayudando a definir el tratamiento de múltiples patologías digestivas. Es de resaltar, para nuestro medio, su utilidad en patologías de difícil diagnóstico como son las estenosis biliares indeterminadas y las neoplasias quísticas pancreáticas, cuyo diagnóstico temprano y exacto es muy difícil con las técnicas actualmente disponibles, y que es necesario para definir la realización o la exclusión de tratamientos quirúrgicos de alta morbimortalidad y alto costo, como por ejemplo, la cirugía de Whipple. En esta revisión se muestran los aportes actuales de esta tecnología, ya disponible en nuestro medio, para el diagnóstico y estudio de las patologías digestivas.
Probe based confocal laser endomicroscopy (Cellvizio Mauna Kea, Paris) is a new technology that allows performance of histological analysis (optical biopsy) during any endoscopic procedure. This improves diagnosis and helps define the treatment needed for multiple digestive diseases. Its utility for diseases that are difficult to diagnose such as indeterminate biliary strictures and pancreatic cystic neoplasms is noteworthy. Early and accurate diagnoses can be very difficult with currently available techniques, but they are exactly what are needed to determine whether or not expensive surgical treatments with great potential morbidity, for example the Whipple procedure, need to be performed. This review looks at the contribution that this technology can make in our country where it is now available for the diagnosis and study of digestive diseases.
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Humans , Gastrointestinal Neoplasms , Mass Screening , Microscopy, ConfocalABSTRACT
Confocal laser endomicroscopy (CLE) is a new technology enabling endoscopists to visualize tissue at the cellular level. CLE has the fundamental potential to provide a histologic diagnosis, and may theoretically replace or reduce the need for performing biopsy for histology. The clinical benefits of CLE are more obvious in esophageal disease, including Barrett's esophagus. Currently, this technology has been adapted to the diagnosis and surveillance of Barrett's esophagus and related neoplasia. Standard white light endoscopy is the primary tool for gastric cancer screening. Currently, the only method available to precisely diagnose these lesions is upper endoscopy with an appropriate biopsy. A recent study showed that CLE could characterize dysplasia or cancer and identify the risk factors for gastric cancer, such as intestinal metaplasia and the presence of Helicobacter pylori in vivo, although fewer studies on CLE were performed on the stomach than on Barrett's esophagus and other esophageal diseases. However, the application of CLE to routine clinical endoscopy continues to be refined. This review focused on the usefulness and future prospects of CLE for gastric premalignant and malignant lesions.
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Barrett Esophagus , Biopsy , Diagnosis , Endoscopy , Esophageal Diseases , Helicobacter pylori , Mass Screening , Metaplasia , Risk Factors , Stomach , Stomach NeoplasmsABSTRACT
Chronic atrophic gastritis( CAG)is a commonly seen digestive tract disease with the histopathological findings of mucosa inflammation,gland atrophy,intestinal metaplasia and dysplasia. Intestinal metaplasia is considered as a typical sign of CAG. In recent years,with the rapid progress of endoscopic technique,new technology has been applied for the diagnosis of CAG. This article reviewed the advances in studies on ordinary endoscopy,narrow-band imaging technique,magnifying endoscopy,narrow-band imaging-magnifying endoscopy and confocal laser endomicroscopy for the diagnosis of CAG.
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At present,the diagnosis of gastric cancer and precancerous changes mainly depends on the histological examination of biopsy samples.Confocal laser endomicroscopy could enable realtime observation of tissue,cellular,and subcellular structure of gastrointestinal tract,and differentiate normal,hyperplastic,and neoplastic mucosa.Confocal laser endomicroscopy has shown the superiority and value in in vivo diagnosis of gastric cancer and precancerous changes, including atrophic gastritis,intestinal metaplasia,and intraepithelial neoplasia,et al.This article reviewed the advances in studies of the diagnosis of gastric cancer and precancerous changes by confocal laser endomicroscopy.
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Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.