Confocal Laser Endomicroscopy (CLE)

  •                                  Principle of Confocal Laser Endomicroscopy:
  • – Fluorescent dye is taken up by normal mucosal cells but dysplastic cells or malignanat cells do not uptake the fluorescent
  •                                              Types:
  • – There are 2 commercially available methods
  •          1. Endoscope base
  •         2. Probe based : instrument that can be passed through the accessory channel of the standard upper endoscope
  •                                
  •                                   Commonly used dye in CLE:
  •                          – I.V fluorescin sodium or
  •                          – Topical acriflavin or cresyl violet
  • – Confocal Laser Endomicroscopy (CLE) is an advanced endoscopic imaging modality that provides histology-like images at 1000 fold magnification for in vivo microscopic evaluation
  • – Initially it was developed for an endoscope-integrated CLE (e-CLE) with specific application to upper and lower GI endoscopy. Later a probe-based CLE system (p-CLE) has been developed
  • – Nowadays only p-CLE is commercially available with the advantage that it can be used in other parts of the GIT as in biliopancreatic disease through ERCP and EUS
  • – Several studies have demonstrated a high correlation of results between CLE and histopathology in GI lesion
  • – CLE has overcome some of the limitation found in endoscopy (macroscopy) and the histopathology (microscopy) thus improving patient management
  • – CLE helps ‘Diagnostic Doubt’
  •     **A patient with Barrett’s esophagus and dysplasia at histopathology but without dysplasia criteria at high definition of chromoendoscopy have diagnostic benefits using CLE

 

  •                            Advantages:
  • – It allows real-time, in vivo microscopic imaging of the mucosa
  • – It creates 1000 times magnification
  • – It reduces the number of biopsy needed per patient
  • – It significantly improves tyhe diagnostic yield after endoscopically unapparent dysplasia

       Limitation of Confocal Laser Endomicroscopy:

  • Histopathology is the gold standard technique for final diagnosis of disease. Histopathology, however, could have 20-30% misdiagnosis rate due to many factors such as interpretation mistakes, biopsy site inaccuracy or number of biopsy

 


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