Confocal laser endomicroscopy in gastro-intestinal endoscopy: technical aspects and clinical applications

Nastazja Dagny Pilonis, Wladyslaw Januszewicz, Massimiliano di Pietro, Nastazja Dagny Pilonis, Wladyslaw Januszewicz, Massimiliano di Pietro

Abstract

Confocal laser endomicroscopy (CLE) is an advanced endoscopic imaging technology that provides a magnified, cellular level view of gastrointestinal epithelia. In conjunction with topical or intravenous fluorescent dyes, CLE allows for an "optical biopsy" for real-time diagnosis. Two different CLE system have been used in clinical endoscopy, probe-based CLE (pCLE) and endoscope-based CLE (eCLE). Using pCLE, the device can be delivered: (I) into the luminal gastrointestinal tract through the working channel of standard endoscopes; (II) into extraluminal cystic and solid parenchymal lesions through an endoscopic ultrasound (EUS) needle; or (III) into the biliary system through an endoscopic retrograde cholangiopancreatography (ERCP) accessory channel. With eCLE, the probe is directly integrated into the tip of a conventional endoscope, however, these endoscopes are no longer commercially available. CLE has moderate to high diagnostic accuracy for neoplastic and inflammatory conditions through the gastrointestinal tract including: oesophageal, gastric and colonic neoplasia, pancreatic cysts and solid lesions, malignant pancreatobiliary strictures and inflammatory bowel disease. Some studies have demonstrated the diagnostic benefit of CLE imaging when combined with either conventional white light endoscopy or advanced imaging technologies. Therefore, optical biopsies using CLE can resolve diagnostic dilemmas in some cases where conventional imaging fails to achieve conclusive results. CLE could also reduce the requirement for extensive tissue sampling during surveillance procedures. In the future, CLE in combination with molecular probes, could allow for the molecular characterization of diseases and assess response to targeted therapy. However, the narrow field of view, high capital costs and specialized operator training requirements remain the main limitations. Future multi-center, randomized trials with a focus on conventional diagnostic applications, cost-effectiveness and standardized training will be required for definitive evidence. The objective of this review is to evaluate the technical aspects and current applications of CLE in patients with gastrointestinal and pancreatobiliary diseases and discuss future directions for this technique.

Keywords: Confocal laser endomicroscopy (CLE); colon cancer; esophageal cancer; fluorescent endoscopy; image enhanced endoscopy; inflammatory bowel disease (IBD); pancreatic cancer; stomach cancer.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh.2020.04.02/coif). The series “Advanced endoscopic imaging of the GI tract” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

2022 Translational Gastroenterology and Hepatology. All rights reserved.

Figures

Figure 1
Figure 1
Principles of confocal laser endomicroscopy. The light passing through a pinhole is reflected by the beam splitter and then focused by the objective lens. The tissue is illuminated and the fluorescence emitted is collected by the objective. A pin hole placed before the detector allows to reject the light signal from out-of-focus tissue layers. Magnification: 10×.
Figure 2
Figure 2
CLE technologies. (A) Probe-based confocal laser endomicroscopy system (pCLE) (Mauna Kea Technologies, Paris, France). (B) pCLE probe can be delivered in vivo through the standard 2.8 mm endoscope channel. (C) Endoscope-based confocal laser endomicroscopy (eCLE). The arrows point to the different components of the eCLE system. Adapted from De Palma GD, World J Gastroenterol, 2009. CLE, confocal laser endomicroscopy.
Figure 3
Figure 3
Normal squamous epithelium in oesophagus-dark, homogeneous epithelial cells with regular architecture and clearly visible borders, capillaries directed toward the epithelium within the lamina propria, without penetration of the contrast agent into the surrounding tissue. Adapted from Templeton A, et al., Clin Endosc, 2013.
Figure 4
Figure 4
pCLE criteria for low-grade dysplasia and high-grade dysplasia in Barrett’s oesophagus. (A) Dark non-round glands. (B) Variable degree of darkness with sharp cut-off. (C) Cellular stratification. (D) Poorly identifiable goblet cells. (E) Glands unequal in size and shape. (F) Non-equidistant and irregular cells. (G) “Saw-toothed” epithelial surface. (H) Non-equidistant glands. (I) Enlarged cells. pCLE, probe-based confocal laser endomicroscopy.
Figure 5
Figure 5
Oesophageal squamous carcinoma-squamous cells are irregularly arranged and differ in size and morphology. Capillary leakage of fluorescein is observed. Magnification: 1,000×. Adapted from Liu J, et al., PLoS One, 2014.
Figure 6
Figure 6
The pCLE appearance of normal and pathological gastric mucosa. (A) Normal cardiac mucosa-regular pits with wide openings. (B) Dysplastic gastric-dark epithelium with irregular and varying thickness is observed. (C) Differentiated adenocarcinoma-disorganized epithelium with dark and irregular glands. (D) Undifferentiated adenocarcinoma-dark and irregular cells with no identifiable glandular structures are observed. Adapted from Kin MY, et al., World J Gastroenterol, 2016. pCLE, probe-based confocal laser endomicroscopy.
Figure 7
Figure 7
The eCLE appearance of normal and pathological gastric mucosa. (A) Normal gastric mucosa in the fundus - gastric pits are round (solid arrow), net-like subepithelial capillary network patterns surround the gastric pits (dash arrow). (B) Normal gastric mucosa in the body-gastric pits are round (solid arrow). Honeycomb-like subepithelial capillary network patterns surround the gastric pits (dash arrows). (C) Normal gastric mucosa in the antrum-gastric pits are the line type (solid arrow). Coil-shaped subepithelial capillary network patterns surround the gastric pits (dash arrow). (D) Low grade gastric intraepithelial neoplasia-different sizes of gastric pits, capillary network is thickening and circuitous. (E) High grade gastric intraepithelial neoplasia-abnormal arrangement of gastric pits. The thickening capillary network and the increasing branch present a mass shape. Magnification: 1,000×. Adapted from Shu-Fang W, et al., World J Gastroenterol, 2012. eCLE, endoscope-based confocal laser endomicroscopy.
Figure 8
Figure 8
The CLE appearance of normal and pathological small bowel mucosa. (A) Normal small bowel mucosa-normal epithelium border with regular capillary pattern. (B) Confocal image of celiac disease-Marsh type 3b. Magnification: 1,000×. Adapted from De Palma, GD, World J Gastroenterol, 2009; Venkatesh K, World J Gastroenterol, 2009. CLE, confocal laser endomicroscopy.
Figure 9
Figure 9
nCLE images of pancreas. (A) Intraductal papillary mucinous neoplasm: a single papilla with a central fibrovascular core and overlying epithelium. (B) Serous cystadenoma: branching and tortuous network of multiple blood vessels in a “fern like” pattern. (C) Pseudocyst: clusters of bright, floating particles with a background which is nondescript and lacks blood vessels. (D) Mucinous cystic neoplasm: solitary epithelial bands without formation of papillae. Adapted from Krishna G, et al., World J Gastroenterol, 2015. nCLE, needle-based confocal laser endomicroscopy.
Figure 10
Figure 10
CLE images of biliary ducts. (A) Normal bile duct-reticular network of thin dark branching bands ≤20 µm. (B-E) Features of malignant bile duct strictures: (B) thick white bands (>20 µm), (C) thick dark bands (>40 µm), (D) epithelium, (E) dark clumps. (F-J) features of inflammatory bile duct strictures on confocal laser endomicroscopy: (F) thickened reticular structures, (G) multiple white bands, (H) dark granular pattern in scales, (I) increased spaces between scales. Magnification: 1,000×. Adopted from Almadi et al., World J Gastroenterol, 2015. CLE, confocal laser endomicroscopy.
Figure 11
Figure 11
CLE images of colonic mucosa. (A) Normal colonic mucosa-round shaped crypts, dark goblet cells, narrow and regular blood vessels surrounding the crypts. (B) Adenomatous polyp-irregular or villiform structures and a dark, irregularly thickened epithelium with a decreased number of goblet cells. (C) Adenocarcinoma-disorganized mucosa, lack of structure, elongated crypts, irregularly thickened epithelium, dilated and distorted blood vessels. Adapted from De Palma GD, et al., World J Gastroenterol, 2009. CLE, confocal laser endomicroscopy.
Figure 12
Figure 12
CLE images in inflammatory bowel diseases. (A) Active ulcerative colitis (distal colitis-the switch from normal mucosa (top of the figure) to inflamed mucosa with irregular arrangement of crypts, crypt fusion and capillaries alterations. (B) Crohn’s disease-dilated and distorted capillaries, altered crypt architecture, increased distance between the crypts. Magnification: 1,000×. Adapted from De Palma GD, et al., World J Gastroenterol, 2013. CLE, confocal laser endomicroscopy.

References

    1. Goetz M, Toermer T, Vieth M, et al. Simultaneous confocal laser endomicroscopy and chromoendoscopy with topical cresyl violet. Gastrointest Endosc 2009;70:959-68. 10.1016/j.gie.2009.04.016
    1. Li CQ, Yu T, Zuo XL, et al. Effects on confocal laser endomicroscopy image quality by different acriflavine concentrations. J Interv Gastroenterol 2011;1:59-63. 10.4161/jig.1.2.16828
    1. Meyer RR, Simpson MV. DNA biosynthesis in mitochondria. Differential inhibition of mitochondrial and nuclear DNA polymerases by the mutagenic dyes ethidium bromide and acriflavin. Biochem Biophys Res Commun 1969;34:238-44. 10.1016/0006-291X(69)90637-8
    1. Caulfield MJ, Burleson GR, Pollard M. Ozonation of mutagenic and carcinogenic alkylating agents, pesticides, aflatoxin B1, and benzidine in water. Cancer Res 1979;39:2155-9.
    1. Wallace MB, Meining A, Canto MI, et al. The safety of intravenous fluorescein for confocal laser endomicroscopy in the gastrointestinal tract. Aliment Pharmacol Ther 2010;31:548-52. 10.1111/j.1365-2036.2009.04207.x
    1. Rzouq F, Vennalaganti P, Pakseresht K, et al. In-class didactic versus self-directed teaching of the probe-based confocal laser endomicroscopy (pCLE) criteria for Barrett’s esophagus. Endoscopy 2016;48:123-7.
    1. Pittayanon R, Rerknimitr R, Wisedopas N, et al. The learning curve of gastric intestinal metaplasia interpretation on the images obtained by probe-based confocal laser endomicroscopy. Diagn Ther Endosc 2012;2012:278045. 10.1155/2012/278045
    1. Kuiper T, Kiesslich R, Ponsioen C, et al. The learning curve, accuracy, and interobserver agreement of endoscope-based confocal laser endomicroscopy for the differentiation of colorectal lesions. Gastrointest Endosc 2012;75:1211-7. 10.1016/j.gie.2012.01.040
    1. Gaddam S, Mathur SC, Singh M, et al. Novel probe-based confocal laser endomicroscopy criteria and interobserver agreement for the detection of dysplasia in Barrett’s esophagus. Am J Gastroenterol 2011;106:1961-9. 10.1038/ajg.2011.294
    1. Buchner AM, Gomez V, Heckman MG, et al. The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia. Gastrointest Endosc 2011;73:556-60. 10.1016/j.gie.2011.01.002
    1. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut 2014;63:7-42. 10.1136/gutjnl-2013-305372
    1. Shaheen NJ, Falk GW, Iyer PG, et al. Corrigendum: ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol 2016;111:1077. 10.1038/ajg.2016.186
    1. Neumann H, Langner C, Neurath MF, et al. Confocal Laser Endomicroscopy for Diagnosis of Barrett’s Esophagus. Front Oncol 2012;2:42. 10.3389/fonc.2012.00042
    1. di Pietro M, Bertani H, O’Donovan M, et al. Development and Validation of Confocal Endomicroscopy Diagnostic Criteria for Low-Grade Dysplasia in Barrett’s Esophagus. Clin Transl Gastroenterol 2019;10:e00014. 10.14309/ctg.0000000000000014
    1. Sharma P, Meining AR, Coron E, et al. Real-time increased detection of neoplastic tissue in Barrett’s esophagus with probe-based confocal laser endomicroscopy: final results of an international multicenter, prospective, randomized, controlled trial. Gastrointest Endosc 2011;74:465-72. 10.1016/j.gie.2011.04.004
    1. Canto MI, Anandasabapathy S, Brugge W, et al. In vivo endomicroscopy improves detection of Barrett’s esophagus-related neoplasia: a multicenter international randomized controlled trial (with video). Gastrointest Endosc 2014;79:211-21. 10.1016/j.gie.2013.09.020
    1. Wu J, Pan YM, Wang TT, et al. Confocal laser endomicroscopy for detection of neoplasia in Barrett’s esophagus: a meta-analysis. Dis Esophagus 2014;27:248-54. 10.1111/dote.12085
    1. di Pietro M, Bird-Lieberman EL, Liu X, et al. Autofluorescence-Directed Confocal Endomicroscopy in Combination With a Three-Biomarker Panel Can Inform Management Decisions in Barrett’s Esophagus. Am J Gastroenterol 2015;110:1549-58. 10.1038/ajg.2015.295
    1. Pech O, Rabenstein T, Manner H, et al. Confocal laser endomicroscopy for in vivo diagnosis of early squamous cell carcinoma in the esophagus. Clin Gastroenterol Hepatol 2008;6:89-94. 10.1016/j.cgh.2007.10.013
    1. Safatle-Ribeiro AV, Baba ER, Faraj SF, et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy in Lugol-unstained esophageal superficial lesions of patients with head and neck cancer. Gastrointest Endosc 2017;85:1195-207. 10.1016/j.gie.2016.09.031
    1. Zhang JN, Li YQ, Zhao YA, et al. Classification of gastric pit patterns by confocal endomicroscopy. Gastrointest Endosc 2008;67:843-53. 10.1016/j.gie.2008.01.036
    1. Li Z, Zuo XL, Li CQ, et al. New Classification of Gastric Pit Patterns and Vessel Architecture Using Probe-based Confocal Laser Endomicroscopy. J Clin Gastroenterol 2016;50:23-32. 10.1097/MCG.0000000000000298
    1. He XK, Liu D, Sun LM. Diagnostic performance of confocal laser endomicroscopy for optical diagnosis of gastric intestinal metaplasia: a meta-analysis. BMC Gastroenterol 2016;16:109. 10.1186/s12876-016-0515-3
    1. Qian W, Bai T, Wang H, et al. Meta-analysis of confocal laser endomicroscopy for the diagnosis of gastric neoplasia and adenocarcinoma. J Dig Dis 2016;17:366-76. 10.1111/1751-2980.12357
    1. Li Z, Zuo XL, Yu T, et al. Confocal laser endomicroscopy for in vivo detection of gastric intestinal metaplasia: a randomized controlled trial. Endoscopy 2014;46:282-90. 10.1055/s-0033-1359215
    1. Pittayanon R, Rerknimitr R, Wisedopas N, et al. Flexible spectral imaging color enhancement plus probe-based confocal laser endomicroscopy for gastric intestinal metaplasia detection. J Gastroenterol Hepatol 2013;28:1004-9. 10.1111/jgh.12185
    1. Zuo XL, Li Z, Li CQ, et al. Probe-based endomicroscopy for in vivo detection of gastric intestinal metaplasia and neoplasia: a multicenter randomized controlled trial. Endoscopy 2017;49:1033-42. 10.1055/s-0043-115382
    1. Lim LG, Yeoh KG, Srivastava S, et al. Comparison of probe-based confocal endomicroscopy with virtual chromoendoscopy and white-light endoscopy for diagnosis of gastric intestinal metaplasia. Surg Endosc 2013;27:4649-55. 10.1007/s00464-013-3098-x
    1. Kiesslich R, Goetz M, Burg J, et al. Diagnosing Helicobacter pylori in vivo by confocal laser endoscopy. Gastroenterology 2005;128:2119-23. 10.1053/j.gastro.2004.12.035
    1. Fugazza A, Gaiani F, Carra MC, et al. Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis. Biomed Res Int 2016;2016:4638683. 10.1155/2016/4638683
    1. Ohmiya N, Horiguchi N, Tahara T, et al. In vivo characterization of abnormalities in small-bowel diseases using probe-based confocal laser endomicroscopy. Endosc Int Open 2017;5:E547-58. 10.1055/s-0043-106184
    1. Trovato C, Sonzogni A, Ravizza D, et al. Celiac disease: in vivo diagnosis by confocal endomicroscopy. Gastrointest Endosc 2007;65:1096-9. 10.1016/j.gie.2006.10.022
    1. Günther U, Daum S, Heller F, et al. Diagnostic value of confocal endomicroscopy in celiac disease. Endoscopy 2010;42:197-202. 10.1055/s-0029-1243937
    1. Leong RW, Nguyen NQ, Meredith CG, et al. In vivo confocal endomicroscopy in the diagnosis and evaluation of celiac disease. Gastroenterology 2008;135:1870-6. 10.1053/j.gastro.2008.08.054
    1. Pittayanon R, Rerknimitr R, Imraporn B, et al. Diagnostic values of dual focus narrow band imaging and probe-based confocal laser endomicroscopy in FAP-related duodenal adenoma. Endosc Int Open 2015;3:E450-5. 10.1055/s-0034-1392235
    1. Fritscher-Ravens A, Schuppan D, Ellrichmann M, et al. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology 2014;147:1012-20.e4. 10.1053/j.gastro.2014.07.046
    1. Modi RM, Swanson B, Muscarella P, 2nd, et al. Novel techniques for diagnosis of serous cystadenoma: fern pattern of vascularity confirmed by in vivo and ex vivo confocal laser endomicroscopy. Gastrointest Endosc 2017;85:258-9. 10.1016/j.gie.2016.07.015
    1. Napoleon B, Lemaistre AI, Pujol B, et al. In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy (nCLE): proposition of a comprehensive nCLE classification confirmed by an external retrospective evaluation. Surg Endosc 2016;30:2603-12. 10.1007/s00464-015-4510-5
    1. Krishna SG, Brugge WR, Dewitt JM, et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc 2017;86:644-54.e2. 10.1016/j.gie.2017.03.002
    1. Nakai Y, Iwashita T, Park DH, et al. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204-14. 10.1016/j.gie.2014.10.025
    1. Krishna SG, Swanson B, Hart PA, et al. Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions. Endosc Int Open 2016;4:E1124-35. 10.1055/s-0042-116491
    1. Napoleon B, Palazzo M, Lemaistre AI, et al. Needle-based confocal laser endomicroscopy of pancreatic cystic lesions: a prospective multicenter validation study in patients with definite diagnosis. Endoscopy 2019;51:825-35. 10.1055/a-0732-5356
    1. Teubner D, Kiesslich R, Matsumoto T, et al. Beyond standard image-enhanced endoscopy confocal endomicroscopy. Gastrointest Endosc Clin N Am 2014;24:427-34. 10.1016/j.giec.2014.03.012
    1. Konda VJ, Meining A, Jamil LH, et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy 2013;45:1006-13. 10.1055/s-0033-1344714
    1. Kadayifci A, Atar M, Basar O, et al. Needle-Based Confocal Laser Endomicroscopy for Evaluation of Cystic Neoplasms of the Pancreas. Dig Dis Sci 2017;62:1346-53. 10.1007/s10620-017-4521-2
    1. Giovannini M, Caillol F, Monges G, et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in solid pancreatic masses. Endoscopy 2016;48:892-8. 10.1055/s-0042-112573
    1. Kongkam P, Pittayanon R, Sampatanukul P, et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions (ENES): a pilot study. Endosc Int Open 2016;4:E17-23.
    1. Karstensen JG, Cartana T, Constantinescu C, et al. Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses - a prospective validation study. Endosc Int Open 2018;6:E78-85. 10.1055/s-0043-121987
    1. Ponchon T, Gagnon P, Berger F, et al. Value of endobiliary brush cytology and biopsies for the diagnosis of malignant bile duct stenosis: results of a prospective study. Gastrointest Endosc 1995;42:565-72. 10.1016/S0016-5107(95)70012-9
    1. Navaneethan U, Njei B, Lourdusamy V, et al. Comparative effectiveness of biliary brush cytology and intraductal biopsy for detection of malignant biliary strictures: a systematic review and meta-analysis. Gastrointest Endosc 2015;81:168-76. 10.1016/j.gie.2014.09.017
    1. Slivka A, Gan I, Jamidar P, et al. Validation of the diagnostic accuracy of probe-based confocal laser endomicroscopy for the characterization of indeterminate biliary strictures: results of a prospective multicenter international study. Gastrointest Endosc 2015;81:282-90. 10.1016/j.gie.2014.10.009
    1. Meining A, Chen YK, Pleskow D, et al. Direct visualization of indeterminate pancreaticobiliary strictures with probe-based confocal laser endomicroscopy: a multicenter experience. Gastrointest Endosc 2011;74:961-8. 10.1016/j.gie.2011.05.009
    1. Caillol F, Bories E, Autret A, et al. Evaluation of pCLE in the bile duct: final results of EMID study: pCLE: impact in the management of bile duct strictures. Surg Endosc 2015;29:2661-8. 10.1007/s00464-014-3986-8
    1. Meining A, Shah RJ, Slivka A, et al. Classification of probe-based confocal laser endomicroscopy findings in pancreaticobiliary strictures. Endoscopy 2012;44:251-7. 10.1055/s-0031-1291545
    1. Caillol F, Filoche B, Gaidhane M, et al. Refined probe-based confocal laser endomicroscopy classification for biliary strictures: the Paris Classification. Dig Dis Sci 2013;58:1784-9. 10.1007/s10620-012-2533-5
    1. Gao YD, Qu YW, Liu HF. Comparison of diagnostic efficacy between CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures: a meta-analysis. Scand J Gastroenterol 2018;53:482-9. 10.1080/00365521.2018.1448435
    1. Sun B, Moon JH, Cai Q, et al. Review article: Asia-Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures. Aliment Pharmacol Ther 2018;48:138-51. 10.1111/apt.14811
    1. Anderson MA, Appalaneni V, Ben-Menachem T, et al. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013;77:167-74. 10.1016/j.gie.2012.09.029
    1. Talreja JP, Turner BG, Gress FG, et al. Pre- and post-training session evaluation for interobserver agreement and diagnostic accuracy of probe-based confocal laser endomicroscopy for biliary strictures. Dig Endosc 2014;26:577-80. 10.1111/den.12214
    1. Kahaleh M, Turner BG, Bezak K, et al. Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management. Dig Liver Dis 2015;47:202-4. 10.1016/j.dld.2014.11.006
    1. Wallace M, Lauwers GY, Chen Y, et al. Miami classification for probe-based confocal laser endomicroscopy. Endoscopy 2011;43:882-91. 10.1055/s-0030-1256632
    1. De Palma GD, Staibano S, Siciliano S, et al. In vivo characterisation of superficial colorectal neoplastic lesions with high-resolution probe-based confocal laser endomicroscopy in combination with video-mosaicing: a feasibility study to enhance routine endoscopy. Dig Liver Dis 2010;42:791-7. 10.1016/j.dld.2010.03.009
    1. Shahid MW, Buchner AM, Coron E, et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy in detecting residual colorectal neoplasia after EMR: a prospective study. Gastrointest Endosc 2012;75:525-33. 10.1016/j.gie.2011.08.024
    1. Buchner AM, Shahid MW, Heckman MG, et al. Comparison of probe-based confocal laser endomicroscopy with virtual chromoendoscopy for classification of colon polyps. Gastroenterology 2010;138:834-42. 10.1053/j.gastro.2009.10.053
    1. Parikh ND, Gibson J, Nagar A, et al. Confocal laser endomicroscopy features of sessile serrated adenomas/polyps. United European Gastroenterol J 2016;4:599-603. 10.1177/2050640615621819
    1. Wanders LK, East JE, Uitentuis SE, et al. Diagnostic performance of narrowed spectrum endoscopy, autofluorescence imaging, and confocal laser endomicroscopy for optical diagnosis of colonic polyps: a meta-analysis. Lancet Oncol 2013;14:1337-47. 10.1016/S1470-2045(13)70509-6
    1. Shahid MW, Buchner AM, Heckman MG, et al. Diagnostic accuracy of probe-based confocal laser endomicroscopy and narrow band imaging for small colorectal polyps: a feasibility study. Am J Gastroenterol 2012;107:231-9. 10.1038/ajg.2011.376
    1. Abe S, Saito Y, Oono Y, et al. Pilot study on probe-based confocal laser endomicroscopy for colorectal neoplasms: an initial experience in Japan. Int J Colorectal Dis 2018;33:1071-8. 10.1007/s00384-018-3059-x
    1. Rasmussen DN, Karstensen JG, Riis LB, et al. Confocal Laser Endomicroscopy in Inflammatory Bowel Disease--A Systematic Review. J Crohns Colitis 2015;9:1152-9. 10.1093/ecco-jcc/jjv131
    1. Hundorfean G, Chiriac MT, Mudter J, et al. Confocal laser endomicroscopy provides potential differentiation criteria between Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis 2013;19:E61-4. 10.1002/ibd.23033
    1. Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut 2012;61:1619-35. 10.1136/gutjnl-2012-302830
    1. Musquer N, Coquenlorge S, Bourreille A, et al. Probe-based confocal laser endomicroscopy: a new method for quantitative analysis of pit structure in healthy and Crohn’s disease patients. Dig Liver Dis 2013;45:487-92. 10.1016/j.dld.2013.01.018
    1. Lim LG, Neumann J, Hansen T, et al. Confocal endomicroscopy identifies loss of local barrier function in the duodenum of patients with Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis 2014;20:892-900. 10.1097/MIB.0000000000000027
    1. Liu JJ, Madsen KL, Boulanger P, et al. Mind the gaps: confocal endomicroscopy showed increased density of small bowel epithelial gaps in inflammatory bowel disease. J Clin Gastroenterol 2011;45:240-5. 10.1097/MCG.0b013e3181fbdb8a
    1. Liu JJ, Wong K, Thiesen AL, et al. Increased epithelial gaps in the small intestines of patients with inflammatory bowel disease: density matters. Gastrointest Endosc 2011;73:1174-80. 10.1016/j.gie.2011.01.018
    1. Neumann H, Vieth M, Gunther C, et al. Virtual chromoendoscopy for prediction of severity and disease extent in patients with inflammatory bowel disease: a randomized controlled study. Inflamm Bowel Dis 2013;19:1935-42. 10.1097/MIB.0b013e318290550e
    1. Li CQ, Xie XJ, Yu T, et al. Classification of inflammation activity in ulcerative colitis by confocal laser endomicroscopy. Am J Gastroenterol 2010;105:1391-6. 10.1038/ajg.2009.664
    1. Buda A, Hatem G, Neumann H, et al. Confocal laser endomicroscopy for prediction of disease relapse in ulcerative colitis: a pilot study. J Crohns Colitis 2014;8:304-11. 10.1016/j.crohns.2013.09.005
    1. Kiesslich R, Duckworth CA, Moussata D, et al. Local barrier dysfunction identified by confocal laser endomicroscopy predicts relapse in inflammatory bowel disease. Gut 2012;61:1146-53. 10.1136/gutjnl-2011-300695
    1. Neurath MF. New targets for mucosal healing and therapy in inflammatory bowel diseases. Mucosal Immunol 2014;7:6-19. 10.1038/mi.2013.73
    1. Tontini GE, Mudter J, Vieth M, et al. Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn’s disease: a pilot study. Endoscopy 2015;47:437-43.
    1. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007;132:874-82. 10.1053/j.gastro.2007.01.048
    1. Hlavaty T, Huorka M, Koller T, et al. Colorectal cancer screening in patients with ulcerative and Crohn’s colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy. Eur J Gastroenterol Hepatol 2011;23:680-9. 10.1097/MEG.0b013e32834791b4
    1. van den Broek FJ, van Es JA, van Eeden S, et al. Pilot study of probe-based confocal laser endomicroscopy during colonoscopic surveillance of patients with longstanding ulcerative colitis. Endoscopy 2011;43:116-22. 10.1055/s-0030-1255954
    1. Su P, Liu Y, Lin S, et al. Efficacy of confocal laser endomicroscopy for discriminating colorectal neoplasms from non-neoplasms: a systematic review and meta-analysis. Colorectal Dis 2013;15:e1-12. 10.1111/codi.12033
    1. Zambelli A, Villanacci V, Buscarini E, et al. Collagenous colitis: a case series with confocal laser microscopy and histology correlation. Endoscopy 2008;40:606-8. 10.1055/s-2008-1077376
    1. Kiesslich R, Hoffman A, Goetz M, et al. In vivo diagnosis of collagenous colitis by confocal endomicroscopy. Gut 2006;55:591-2. 10.1136/gut.2005.084970
    1. De Palma GD, Colavita I, Zambrano G, et al. Detection of colonic dysplasia in patients with ulcerative colitis using a targeted fluorescent peptide and confocal laser endomicroscopy: A pilot study. PLoS One 2017;12:e0180509. 10.1371/journal.pone.0180509
    1. Hsiung PL, Hardy J, Friedland S, et al. Detection of colonic dysplasia in vivo using a targeted heptapeptide and confocal microendoscopy. Nat Med 2008;14:454-8. 10.1038/nm1692
    1. Atreya R, Neumann H, Neufert C, et al. In vivo imaging using fluorescent antibodies to tumor necrosis factor predicts therapeutic response in Crohn’s disease. Nat Med 2014;20:313-8. 10.1038/nm.3462
    1. Li Z, Zuo XL, Li CQ, et al. In vivo molecular imaging of gastric cancer by targeting MG7 antigen with confocal laser endomicroscopy. Endoscopy 2013;45:79-85. 10.1055/s-0032-1325762
    1. Liu L, Yin J, Liu C, et al. In vivo molecular imaging of gastric cancer in human-murine xenograft models with confocal laser endomicroscopy using a tumor vascular homing peptide. Cancer Lett 2015;356:891-8. 10.1016/j.canlet.2014.10.036
    1. Nakai Y, Shinoura S, Ahluwalia A, et al. Molecular imaging of epidermal growth factor-receptor and survivin in vivo in porcine esophageal and gastric mucosae using probe-based confocal laser-induced endomicroscopy: proof of concept. J Physiol Pharmacol 2012;63:303-7.
    1. Hoetker MS, Kiesslich R, Diken M, et al. Molecular in vivo imaging of gastric cancer in a human-murine xenograft model: targeting epidermal growth factor receptor. Gastrointest Endosc 2012;76:612-20. 10.1016/j.gie.2012.05.013
    1. Sturm MB, Joshi BP, Lu S, et al. Targeted imaging of esophageal neoplasia with a fluorescently labeled peptide: first-in-human results. Sci Transl Med 2013;5:184ra61. 10.1126/scitranslmed.3004733

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