High-definition Probe-based Confocal Laser Endomicroscopy Review and Meta-analysis for Neoplasia Detection in Barrett's Esophagus

Abstract

Background and Aims

The goal of this systematic review and meta-analysis was to assess the probe-based confocal laser endomicroscopy (pCLE) benefit as an adjunct to random four-quadrant biopsies in the surveillance of patients with Barrett's esophagus for dysplasia and early esophageal cancer (EAC) detection.

Methods

The MEDLINE and EMBASE databases were systematically searched for studies reporting pCLE detection rates and diagnostic accuracy for esophageal dysplasia and EAC. Three meta-analyses were performed to estimate pooled sensitivities (SEs), specificities (SPs), negative predictive values (NPVs), and per-patient pooled absolute and relative detection rate of neoplasia with 95% confidence intervals (CIs) to compare pCLE detection rate with that of random four-quadrant biopsies.

Results

A total of 9 studies were included (688 patients and 1299 lesions). Per-patient pCLE pooled SEs, SPs, and NPVs were 96% (95% CI 65%-100%), 93% (95% CI 71%-99%), and 98% (95% CI 93%-100%), respectively. Per-lesion pCLE pooled SEs, SPs, and NPVs were 82% (95% CI 63%-92%), 90% (95% CI 84%-94%), and 95% (95% CI 94%-97%), respectively. Compared with random biopsies, the per-patient pooled absolute and relative detection rate increases of neoplasia with pCLE were significant and equal to 5% (95% CI 1%-9%) and 243% (95% CI 122%-482%), respectively.

Conclusion

The addition of pCLE-guided biopsies provides a significantly higher diagnostic yield for dysplasia and cancer and reduces sampling error compared with random four-quadrant biopsies alone. Therefore, pCLE should be considered an important adjunct to Seattle protocol biopsies in patients undergoing screening or surveillance for Barrett's esophagus.