Probe-based confocal laser endomicroscopy with Mauna Kea Technologies’ Cellvizio platform was superior for detecting Barrett’s esophagus compared with the standard Seattle protocol, according to new research presented at the Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery.
“pCLE with Cellvizio is considerably more sensitive in the detection of Barrett’s esophagus than the conventional diagnostic standard (Seattle Protocol), which leaves a majority of epithelium unexamined,” Paul Severson, MD, FACS, co-director of the Minnesota Institute for Minimally Invasive Surgery, told Healio Gastroenterology and Liver Disease. “This effect is seen even in novice users and increases with experience.”
pCLE is an advanced imaging modality that provides microscopic views of the GI mucosa, enables real-time evaluation of entire segments of columnar lined esophagus, and rapidly captures digital images for optical biopsy.
To evaluate the role of pCLE in screening and surveillance for Barrett’s esophagus, Severson and colleagues assessed its ability to identify intestinal metaplasia in 172 patients at eight non-academic centers in the U.S. compared with standard histological analysis of random four quadrant biopsies. The performing endoscopists were all novice pCLE users, with an average of 6.6 months experience. pCLE images were interpreted in real-time and after the procedure.
pCLE detected intestinal metaplasia in 99 patients (57.6%), whereas tissue biopsy detected intestinal metaplasia in 46 (27%). This represents an increase of more than 100%, according to a press release from the manufacturer (P < .0001).
Additionally, a blinded expert who reviewed pCLE images after the procedure confirmed intestinal metaplasia in 56 of 61 patients who had tissue biopsies that tested negative, per the press release.
“Overall, pCLE provides a promising advance in Barrett’s detection, which will likely result in superior identification of individuals at risk for esophageal adenocarcinoma,” Severson said. – by Adam Leitenberger
Richardson C, et al. Abstract S071. Presented at: Society of American Gastrointestinal and Endoscopic Surgeons 2018 Annual Meeting and World Congress of Endoscopic Surgery; April 11-14; Seattle, WA.
Disclosures: Severson reports serving as a preceptor, speaker and consultant for Ethicon/Torax, and as a consultant for Mauna Kea Technologies outside of the current study.