Probe-based confocal laser endomicroscopy: progress, challenges, and emerging applications

Area of Science:

• Gastroenterology
• Medical Technology
• Diagnostic Imaging

Background:

• Probe-based confocal laser endomicroscopy (pCLE) provides cellular-level visualization during endoscopy.
• This technology acts as a real-time "optical biopsy" for gastrointestinal indications.

Purpose of the Study:

• To review the technology, diagnostic performance, clinical utility, safety, and cost-effectiveness of pCLE.
• To synthesize current evidence on pCLE across various gastrointestinal conditions.

Main Methods:

• A targeted narrative review of existing studies, including randomized trials, meta-analyses, and observational research.
• Studies focused on pCLE in Barrett's esophagus, gastric intestinal metaplasia, colorectal neoplasia, IBD, and biliary strictures.
• Outcomes assessed included diagnostic accuracy, impact on biopsy rates and patient management, safety, and cost.

Main Results:

• pCLE significantly enhances neoplasia detection in Barrett's esophagus and improves characterization of colorectal lesions, potentially reducing unnecessary resections.
• Pooled sensitivity and specificity for pCLE in gastric intestinal metaplasia are high (97% and 94%, respectively).
• In IBD surveillance, pCLE identified more neoplasia with fewer biopsies, and in biliary strictures, it improved diagnostic accuracy.

Conclusions:

• pCLE enhances endoscopic decision-making through immediate, near-histologic assessment, enabling targeted biopsies and earlier treatment.
• Wider adoption depends on standardized training, validated interpretation criteria, and further multicenter trials.
• Integration of AI and molecular imaging is crucial for reducing variability and costs, and expanding pCLE's clinical utility.