Robles-Medranda C, Vargas M, Ospina J, Puga-Tejada M, Valero M, Soria M, Bravo G, Robles-Jara C, Lukashok HP. Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis. World J Gastrointest Endosc 2017; 9(8): 389-395 [PMID: 28874959 DOI: 10.4253/wjge.v9.i8.389]
Corresponding Author of This Article
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@ieced.com.ec
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastrointest Endosc. Aug 16, 2017; 9(8): 389-395 Published online Aug 16, 2017. doi: 10.4253/wjge.v9.i8.389
Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis
Carlos Robles-Medranda, Maria Vargas, Jesenia Ospina, Miguel Puga-Tejada, Manuel Valero, Miguel Soria, Gladys Bravo, Carlos Robles-Jara, Hannah Pitanga Lukashok
Carlos Robles-Medranda, Maria Vargas, Jesenia Ospina, Miguel Puga-Tejada, Manuel Valero, Miguel Soria, Gladys Bravo, Carlos Robles-Jara, Hannah Pitanga Lukashok, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil 090505, Ecuador
Author contributions: Robles-Medranda C and Vargas M wrote the paper; Bravo G collected data; Ospina J, Puga-Tejada M, Soria M and Robles-Jara C collected and analyzed the data; Valero M analyzed the data; Robles-Medranda C and Lukashok HP designed the study, analyzed the data, revised the manuscript for important intellectual content and provided final approval the version of the article to be published.
Institutional review board statement: This study was approved by the Ecuadorian Institute of Digestive Disease Institutional Review Board.
Informed consent statement: Informed written consent was obtained from all study participants or their legal guardians prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interests.
Data sharing statement: No additional unpublished data are available.
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@ieced.com.ec
Telephone: +593-4-2109180 Fax: +593-4-2109180
Received: February 27, 2017 Peer-review started: February 28, 2017 First decision: March 28, 2017 Revised: April 10, 2017 Accepted: May 3, 2017 Article in press: May 5, 2017 Published online: August 16, 2017 Processing time: 165 Days and 2.1 Hours
Abstract
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.
Core tip: Endoscopic and histopathological findings are not always certain, thus potentially leading to inaccurate diagnoses and inappropriate therapeutics. The use of confocal laser endomicroscopy has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnoses.
