Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 10, 2016; 8(1): 1-3
Published online Jan 10, 2016. doi: 10.4253/wjge.v8.i1.1
Confocal endomicroscopy: Is it time to move on?
Carlos Robles-Medranda
Carlos Robles-Medranda, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil 090505, Ecuador
Author contributions: Robles-Medranda C solely contributed to this work.
Conflict-of-interest statement: The author has no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Carlos Robles-Medranda, MD, Head of the Endoscopy Division, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Av. Abel Romeo Castillo y Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Ecuador. carlosoakm@yahoo.es
Telephone: +593-4-2109180 Fax: +593-4-2109180
Received: May 28, 2015
Peer-review started: May 31, 2015
First decision: August 16, 2015
Revised: September 5, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: January 10, 2016
Processing time: 225 Days and 3.5 Hours
Abstract

Confocal laser endomicroscopy permits in-vivo microscopy evaluation during endoscopy procedures. It can be used in all the parts of the gastrointestinal tract and includes: Esophagus, stomach, small bowel, colon, biliary tract through and endoscopic retrograde cholangiopancreatography and pancreas through needles during endoscopic ultrasound procedures. Many researches demonstrated a high correlation of results between confocal laser endomicroscopy and histopathology in the diagnosis of gastrointestinal lesions; with accuracy in about 86% to 96%. Moreover, in spite that histopathology remains the gold-standard technique for final diagnosis of any diseases; a considerable number of misdiagnosis rate could be present due to many factors such as interpretation mistakes, biopsy site inaccuracy, or number of biopsies. Theoretically; with the diagnostic accuracy rates of confocal laser endomicroscopy could help in a daily practice to improve diagnosis and treatment management of the patients. However, it is still not routinely used in the clinical practice due to many factors such as cost of the procedure, lack of codification and reimbursement in some countries, absence of standard of care indications, availability, physician image-interpretation training, medico-legal problems, and the role of the pathologist. These limitations are relative, and solutions could be found based on new researches focused to solve these barriers.

Keywords: Confocal laser endomicroscopy; In-vivo microscopy; Barret esophagus; Gastrointestinal cancer; Confocal laser endomicroscopy probe

Core tip: Confocal laser endomicroscopy (CLE) permits in-vivo microscopy evaluation during endoscopy procedures. It can be used in all the parts of the gastrointestinal tract with accuracy in about 86% to 96%. In spite of its high accuracy as well as several clinical applications, CLE is still not used in routine clinical practice. This could be correlated to many factors such as: cost of the procedure, lack of codification and reimbursement in some countries, absence of standard of care indications, availability, physician image-interpretation training, medico-legal problems, and the role of the pathologist. However, these limitations are relative, and solutions could be found based on new research leading to increased consensus overcoming present barriers.