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Confocal endomicroscopy for in vivo prediction of completeness after endoscopic mucosal resection

Byline: Rui Ji (1), Xiu-Li Zuo (1), Chang-Qing Li (1), Cheng-Jun Zhou (2), Yan-Qing Li (1) Keywords: Endoscopic mucosal resection; Confocal laser endomicroscopy; Neoplasia Abstract: Background Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplast... Full description

Journal Title: Surgical Endoscopy 2011, Vol.25(6), pp.1933-1938
Main Author: Ji, Rui
Other Authors: Zuo, Xiu-Li , Li, Chang-Qing , Zhou, Cheng-Jun , Li, Yan-Qing
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: ISSN: 0930-2794 ; E-ISSN: 1432-2218 ; DOI: 10.1007/s00464-010-1490-3
Link: http://dx.doi.org/10.1007/s00464-010-1490-3
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recordid: springer_jour10.1007/s00464-010-1490-3
title: Confocal endomicroscopy for in vivo prediction of completeness after endoscopic mucosal resection
format: Article
creator:
  • Ji, Rui
  • Zuo, Xiu-Li
  • Li, Chang-Qing
  • Zhou, Cheng-Jun
  • Li, Yan-Qing
subjects:
  • Endoscopic mucosal resection
  • Confocal laser endomicroscopy
  • Neoplasia
ispartof: Surgical Endoscopy, 2011, Vol.25(6), pp.1933-1938
description: Byline: Rui Ji (1), Xiu-Li Zuo (1), Chang-Qing Li (1), Cheng-Jun Zhou (2), Yan-Qing Li (1) Keywords: Endoscopic mucosal resection; Confocal laser endomicroscopy; Neoplasia Abstract: Background Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplastic lesions. Residual neoplastic tissue of the resection interface is difficult to detect by conventional endoscopy. The aim of this study is to assess the efficacy of confocal laser endomicroscopy (CLE) in predicting complete resection margins after EMR. Methods EMR was performed by using cap-assisted or "inject and cut" resection technique. Two weeks after EMR, the circumferential margins of the defect were inspected by using CLE, and completeness of excision was predicted from the CLE image. Additional EMR was performed if necessary. In vivo CLE diagnosis was validated against final histopathology. Results Twenty-seven lesions were removed by EMR in 27 patients. After excluding 3 patients for gastrectomy, a total of 24 patients underwent CLE assessment, of whom 9 with indefinite lateral margins underwent at least two consecutive CLE follow-ups. A total of 19 lesions were regarded as complete remission, and 5 lesions (21.7%) were incompletely excised according to final pathologic diagnosis. Accuracy of CLE in predicting incomplete resection for original lesions was 91.7%, with sensitivity and specificity of 100.0 and 89.5%, respectively. The residual lesions were treated by additional EMR guided by CLE. There was no recurrence on endoscopic biopsies at mean (range) follow-up of 8.3 (4--15) months. Conclusions Confocal laser endomicroscopy has high accuracy for prediction of remnant tissue after EMR, and may lead to significant improvements in clinical surveillance after endoscopic resection. Author Affiliation: (1) Department of Gastroenterology, Shandong University Qilu Hospital, 107 Wenhuaxi Road, Jinan, 250012, China (2) Department of Pathology, The Second Affiliated Hospital, Shandong University, Jinan, China Article History: Registration Date: 12/11/2010 Received Date: 30/08/2010 Accepted Date: 22/10/2010 Online Date: 07/12/2010
language: eng
source:
identifier: ISSN: 0930-2794 ; E-ISSN: 1432-2218 ; DOI: 10.1007/s00464-010-1490-3
fulltext: fulltext
issn:
  • 1432-2218
  • 14322218
  • 0930-2794
  • 09302794
url: Link


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titleConfocal endomicroscopy for in vivo prediction of completeness after endoscopic mucosal resection
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descriptionByline: Rui Ji (1), Xiu-Li Zuo (1), Chang-Qing Li (1), Cheng-Jun Zhou (2), Yan-Qing Li (1) Keywords: Endoscopic mucosal resection; Confocal laser endomicroscopy; Neoplasia Abstract: Background Endoscopic mucosal resection (EMR) is an alternative to surgery for removal of superficial gastric neoplastic lesions. Residual neoplastic tissue of the resection interface is difficult to detect by conventional endoscopy. The aim of this study is to assess the efficacy of confocal laser endomicroscopy (CLE) in predicting complete resection margins after EMR. Methods EMR was performed by using cap-assisted or "inject and cut" resection technique. Two weeks after EMR, the circumferential margins of the defect were inspected by using CLE, and completeness of excision was predicted from the CLE image. Additional EMR was performed if necessary. In vivo CLE diagnosis was validated against final histopathology. Results Twenty-seven lesions were removed by EMR in 27 patients. After excluding 3 patients for gastrectomy, a total of 24 patients underwent CLE assessment, of whom 9 with indefinite lateral margins underwent at least two consecutive CLE follow-ups. A total of 19 lesions were regarded as complete remission, and 5 lesions (21.7%) were incompletely excised according to final pathologic diagnosis. Accuracy of CLE in predicting incomplete resection for original lesions was 91.7%, with sensitivity and specificity of 100.0 and 89.5%, respectively. The residual lesions were treated by additional EMR guided by CLE. There was no recurrence on endoscopic biopsies at mean (range) follow-up of 8.3 (4--15) months. Conclusions Confocal laser endomicroscopy has high accuracy for prediction of remnant tissue after EMR, and may lead to significant improvements in clinical surveillance after endoscopic resection. Author Affiliation: (1) Department of Gastroenterology, Shandong University Qilu Hospital, 107 Wenhuaxi Road, Jinan, 250012, China (2) Department of Pathology, The Second Affiliated Hospital, Shandong University, Jinan, China Article History: Registration Date: 12/11/2010 Received Date: 30/08/2010 Accepted Date: 22/10/2010 Online Date: 07/12/2010
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