Author Discussion Series- Joo Young Cho

An Original Article: Human Clinical Trial from the June issue: “The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia (with videos)” by Gene Hyun Bok, MD, Seong Ran Jeon, MD, Joo Young Cho, MD, Jun-Hyung Cho, MD, Woong Cheul Lee, MD, So Young Jin, MD, In Ho Choi, MD, Hyun Gun Kim, MD, Tae Hee Lee, MD, and Eui Ju Park, MD

Joo Young Cho, MD, from the Digestive Disease Center at Soonchunhyang University Hospital in Seoul, Korea discusses his article “The accuracy of probe-based confocal endomicroscopy versus conventional endoscopic biopsies for the diagnosis of superficial gastric neoplasia (with videos).”

Endoscopic submucosal dissection (ESD) has been accepted as the standard treatment for gastric dysplasia and early gastric cancer in Korea. Before endoscopic resection, the accurate pathological diagnosis using forceps biopsy is important. However, the inflammatory change after multiple biopsies often results in fibrosis of the submucosal layer, which may interrupt the successful resection. Probe-based confocal endomicroscopy (pCLE) allows real-time, in vivo high-resolution and high-magnification imaging of the GI epithelium. Our study focused on the accuracy of pCLE for the diagnosis of gastric neoplasia compared with conventional forceps biopsy.

In our study, the key feature used to distinguish non-neoplastic tissue, dysplasia, and adenocarcinoma were adopted from the Miami classification. It was useful for predicting the final pathology of resected specimens. In the future, the consensus with pathologists will be required for making current classification more reliable.

In this study, we compared the accuracy of in vivo real-time and offline pCLE with that of conventional biopsies before ESD. Our results showed that the addition of pCLE to conventional endoscopic biopsy diagnosis significantly improved the accuracy of the diagnosis of superficial gastric neoplasia. The interobserver agreement between in vivo and offline pCLE diagnosis was also excellent. pCLE has the potential to compensate for the inherent limitations of a conventional endoscopic biopsy.

Figure 3. A, Gastric dysplasia; dark glandular epithelium of irregular and varying thickness is observed. B, Differentiated adenocarcinoma; irregular and disorganized glands with dark and irregular epithelium are observed. C, Undifferentiated adenocarcinoma; dark and irregular cells with no identifiable glandular pattern are observed (H&E, orig. mag. 100).

In our experience, real-time diagnosis using pCLE was attractive as an endoscopic tool. In the future, it may play an important role in making a decision about therapeutic GI endoscopy.

Read the abstract for this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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