Confocal Laser Endomicroscopy For Differential Diagnosis Gastric Ulcer In Vivo

Background and aimsGastric ulcer is a worldwide disease and we can use conventional endoscopy to observe the appearance of ulcer.But if we want to know whether there are some malignant lesions,we should take histopathological biopsy specimens. Confocal laser endomicroscopy is a new-developed device which can provide high magnification images of the gastrointestinal tract during routine endoscopy examination.It can also provide a real-time histopathological diagnosis ,so CLE has been termed as "optical biopsy".The aim of this study were to estimate the value of confocal laser endomicroscopy for differential diagnosis gastric ulcer in vivo.MethodsPatients who visited Department of Gastroenteroscopy, Qilu Hospital for dyspepsia,abdominal pain,hemafecia or had been diagnosed as gastric ulcer by barium meal examination or endoscopy from October 2008 to February 2009 were selected.43 patients who were diagnosed as gastric ulcer by conventional endoscopic mode of CLE were brought into our study.First, general examination were developed by conventional endoscopic mode of CLE,which provided some information of the location and period of gastric ulcers.Then,we used confocal endoscopic mode of CLE to observe 150 sites of the 43 patients. Biopsy specimens were taken for histopathological diagnosis and we compared the diagnostic results of CLE and histopathology. ResultsA total of 12769 CLE images were obtained from 150 sites of 43 patients. The sensitivities of CLE for phlegmonosis process were 83.54% ,the specificities were 85.92%,the positive predictive value were 86.84%,and the negative predictive value were 82.43%. The kappa value for the correlation with histopathology results and CLE was 0.69 for phlegmonosis process. The sensitivities of CLE for intraepithelial neoplasia were 53.57% ,the specificities were 88.52%,the positive predictive value were 51.72%,and the negative predictive value were 89.26%. The kappa value for the correlation with histopathology results and CLE was 0.42 for intraepithelial neoplasia. The sensitivities of CLE for gastric cancer were 92.68% ,the specificities were 93.46%,the positive predictive value were 84.44%,and the negative predictive value were 95.24%. The kappa value for the correlation with histopathology results and CLE was 0.81 for gastric cancer.ConclusionsConfocal laser endomicroscopy can provide a real-time histopathological diagnosis of the gastrointestinal tract without the help of biopsy specimens. The sensitivities,specificities,positive predictive value and negative predictive value are high.CLE can direct biopsies and elevate the detection rates of precancerous lesions and tumors.