Optical biopsies by confocal endomicroscopy prevent additive endoscopic biopsies before endoscopic submucosal dissection in gastric epithelial neoplasias: a prospective, comparative study

Background: Confocal laser endomicroscopy (CLE) allows real-time in vivo histologic evaluation of GI lesions. To our knowledge, there is no reported prospective study comparing endoscopic and optical biopsy using CLE before endoscopic submucosal dissection (ESD) with post-ESD histopathology. Objective: We compared endoscopic and optical biopsy before ESD and thereby assessed the ability of CLE to effectively diagnose and differentiate gastric epithelial neoplasia. Design: Single tertiary-care center, prospective comparative study. Setting: Soonchunhyang University Hospital, between September 2009 and April 2010. Patients: This study involved 31 patients with 35 gastric epithelial neoplasias, previously diagnosed by endoscopic biopsy, who were scheduled for ESD. Intervention: Target lesions were imaged in vivo by using CLE. Main Outcome Measurements: The overall accuracy of endoscopic and CLE diagnosis was compared with post-ESD histopathology. Results: In histopathology after ESD, 11 of 35 lesions (31.5%) were adenomas and 24 (68.5%) were adenocarcinomas. The overall accuracy of CLE diagnosis of gastric adenomas and adenocarcinomas was significantly higher at 94.2% (95% confidence interval [CI], 81.3-98.4), versus 85.7% (95% CI, 70.6-93.7) for endoscopic biopsy (P = .031). The overall accuracy of CLE diagnosis of differentiated and undifferentiated adenocarcinomas also was higher (95.4%; 95% CI, 78.2-99.1) than that of endoscopic biopsy (84.2%; 95% CI, 62.4-94.4) but did not differ significantly (P = .146). Limitations: Single tertiary-care center experience and small patient number. Conclusion: This study demonstrates the high accuracy of diagnosis of gastric epithelial neoplasia by using CLE. The use of CLE could possibly thus reduce the number of unnecessary biopsies and mistaken diagnoses before ESD. (Gastrointest Endosc 2011;74:772-80.)