In vivo real‐time diagnosis of endoscopic ultrasound‐guided needle‐based confocal laser endomicroscopy in gastric subepithelial lesions. Issue 3 (6th November 2019)

• Record Type: Journal Article
• Authors: Zhang, Ming‐Ming; Zhong, Ning; Gu, Xiang; Wang, Xiao; Zuo, Xiu‐Li; Ji, Rui; Li, Chang‐Qing; Li, Li‐Xiang; Li, Zhen; Yu, Yan‐Bo; Li, Yan‐Qing
• Is Part Of: Journal of gastroenterology and hepatology. Volume 35:Issue 3(2020)
• Page Start: 446
• Page End: 452
• Publication Date: 2019-11-06
• Subjects: endoscopic ultrasound -- gastric subepithelial lesions -- needle‐based confocal laser endomicroscopy -- real‐time diagnosis; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.14863
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background and Aim: The effect of real‐time analysis of needle‐based confocal laser endomicroscopy (nCLE) for gastric subepithelial lesions (SELs) on the diagnostic value is unclear. The study aimed to investigate the diagnostic efficacy of real‐time nCLE for gastric SELs and to assess the technical aspects and safety of real‐time nCLE. Methods: Consecutive patients with gastric SELs ≥ 1 cm were prospectively investigated by endoscopic ultrasound (EUS), followed by nCLE. During EUS‐nCLE, real‐time nCLE diagnosis was made by an expert endoscopist. The procedure‐relative adverse events were assessed and recorded. One‐month washout period later, nCLE videos were reviewed off‐line by the same endoscopist. The nCLE diagnoses were compared with corresponding pathological results. Additionally, image quality and interobserver agreements for the criteria were evaluated by three experienced endomicroscopists. Results: Except for one failing to be punctured, 60 patients completed EUS‐nCLE procedures successfully. Real‐time nCLE had high diagnostic accuracies of ≥ 88.3% for gastric SELs. There were no significant differences between real‐time and off‐line nCLE diagnoses for gastric SELs ( P > 0.05). The overall accuracy of real‐time nCLE for diagnosis of gastric SELs was 86.7%. There were no procedure‐relative adverse events occurred. In addition, the mean image quality score was 3.6 (1 = poor and 5 = excellent). The interobserver agreement was "almost perfect" for ectopic pancreas and "substantial" for gastrointestinal stromal tumor, leiomyoma, and carcinoma. Conclusions: Endoscopic ultrasound‐nCLE could provide in vivo real‐time diagnostic imaging with a high diagnostic accuracy. Meanwhile, real‐time nCLE was feasible and had a satisfactory safety profile.