High-definition Probe-based Confocal Laser Endomicroscopy Review and Meta-analysis for Neoplasia Detection in Barrett's Esophagus

Background and Aims: The goal of this systematic review and meta-analysis was to assess the probe-based confocal laser endomicroscopy (pCLE) benefit as an adjunct to random four-quadrant biopsies in the surveillance of patients with Barrett's esophagus for dysplasia and early esophageal cancer (EAC) detection. Methods: The MEDLINE and EMBASE databases were systematically searched for studies reporting pCLE detection rates and diagnostic accuracy for esophageal dysplasia and EAC. Three meta-analyses were performed to estimate pooled sensitivities (SEs), specificities (SPs), negative predictive values (NPVs), and per-patient pooled absolute and relative detection rate of neoplasia with 95% confidence intervals (CIs) to compare pCLE detection rate with that of random four-quadrant biopsies. Results: A total of 9 studies were included (688 patients and 1299 lesions). Per-patient pCLE pooled SEs, SPs, and NPVs were 96% (95% CI 65%-100%), 93% (95% CI 71%-99%), and 98% (95% CI 93%-100%), respectively. Per-lesion pCLE pooled SEs, SPs, and NPVs were 82% (95% CI 63%-92%), 90% (95% CI 84%-94%), and 95% (95% CI 94%-97%), respectively. Compared with random biopsies, the per-patient pooled absolute and relative detection rate increases of neoplasia with pCLE were significant and equal to 5% (95% CI 1%-9%) and 243% (95% CI 122%-482%), respectively. Conclusion: The addition of pCLE-guided biopsies provides a significantly higher diagnostic yield for dysplasia and cancer and reduces sampling error compared with random four-quadrant biopsies alone. Therefore, pCLE should be considered an important adjunct to Seattle protocol biopsies in patients undergoing screening or surveillance for Barrett's esophagus.