Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis

• 作者: Carlos Robles-Jara Carlos Robles-Medranda Gladys Bravo Hannah Pitanga Lukashok Jesenia Ospina Manuel Valero Maria Vargas Miguel Puga-Tejada Miguel Soria
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: 共焦的激光 endomicroscopy 在 vivo 显微镜学 小型帽子食管 胃肠的癌症 胰腺的包囊 胆汁的苛评
• 年，卷（期）: 2017,（8）
• 页码范围: 389-395
• 页数: 7页
• 分类号: R57

摘要

AIM To evaluate the clinical impact of confocal laser endomicroscopy(CLE) in the diagnosis and management of patients with an uncertain diagnosis.METHODS A retrospective chart review was performed.Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included.Baseline characteristics,indications,previous diagnostic studies,findings at the time of CLE,clinical management and histological results were analyzed.Interventions based on CLE findings were also analyzed.We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.RESULTS A total of 144 patients were included.Of these,51%(74/144) were female.The mean age was 51 years old.In all,41/144(28.4%) lesions were neoplastic(13 bile duct,10 gastric,8 esophageal,6 colonic,1 duodenal,1 rectal,1 ampulloma and 1 pancreatic).The sensitivity,specificity,positive predictive value,negative predictive value,and observed agreement when CLE was used to detect N-lesions were 85.37%,87.38%,72.92%,93.75% and 86.81%,respectively.Cohen’s Kappa was 69.20%,thus indicating good agreement.Changes in management were observed in 54% of the cases.CONCLUSION CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.