探头式激光共聚焦显微内镜对巴雷特食管黏膜肠上皮化生的诊断价值

Diagnostic value of probe‑based confocal laser endomicroscopy for intestinal metaplasia in Barrett esophageal mucosa

摘要:

目的 评估探头式激光共聚焦显微内镜（probe‑based confocal laser endomicroscopy，pCLE）对巴雷特食管黏膜肠上皮化生的诊断效能。方法 前瞻性收集2023年1月至2024年6月在首都医科大学附属北京友谊医院消化内镜中心行pCLE检查的巴雷特食管患者纳入诊断试验研究。入组患者先进行白光+窄带光成像检查，然后应用pCLE对可疑的黏膜进行检查，并进行pCLE引导的靶向活检，最后按巴雷特食管的西雅图方案随机活检。以活检病理结果为金标准，计算pCLE诊断巴雷特食管黏膜肠上皮化生的敏感度、特异度、阳性预测值、阴性预测值和准确率。结果 最终纳入22例巴雷特食管患者，pCLE诊断巴雷特食管黏膜肠上皮化生的敏感度为100.0%（11/11），特异度为63.6%（7/11），阳性预测值为73.3%（11/15），阴性预测值为100.0%（7/7），准确率为81.8%（18/22）。结论 pCLE能够极为敏感地发现巴雷特食管黏膜中的肠上皮化生，有减少多次活检的潜力。

Abstract:

Objective To evaluate the diagnostic efficacy of probe-based confocal laser endomicroscopy (pCLE) for intestinal metaplasia in Barrett esophageal mucosa. Methods Patients with Barrett esophagus who underwent pCLE examination at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University from January 2023 to June 2024 were prospectively included in the diagnostic trial. The enrolled patients first underwent white light and narrow band imaging examination, then pCLE was applied to examine the suspicious mucosa, and targeted biopsies were performed under pCLE guidance. Finally, random biopsies according to the Seattle protocol for Barrett esophagus were conducted. The biopsy pathological results were used as the gold standard to determine the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of pCLE in diagnosing intestinal metaplasia of the mucosa in Barrett esophagus. Results A total of 22 patients with Barrett esophagus were finally included. The sensitivity of pCLE in diagnosing intestinal metaplasia of Barrett esophageal mucosa was 100.0% (11/11), the specificity was 63.6% (7/11), the positive predictive value was 73.3% (11/15), the negative predictive value was 100.0% (7/7), and the accuracy was 81.8% (18/22). Conclusion pCLE shows high sensitivity for identifying intestinal metaplasia in Barrett esophageal and may help reduce the need for multiple biopsies.