Role of Confocal Laser Endomicroscopy in Detection of Residual Barrett's Esophagus after Radiofrequency Ablation

Endoscopic endoluminal radiofrequency ablation (RFA) is a novel and promising modality for Barrett's esophagus (BE) treatment. Actually the only surveillance method after the ablation treatment is random biopsies throughout the whole treated area. Confocal laser endomicroscopy (CLE) is a new endoscopic imaging tool that permits high-resolution microscopic examination of the gastrointestinal tract. The technology has garnered increasing attention because of its ability to provide real-time “optical” biopsy specimens, with a very high sensitivity and specificity. This paper summarize the potential application of CLE in the surveillance of the reepithelialization of BE, after endoscopic RFA

Case Report Role of Confocal Laser Endomicroscopy in Detection of Residual Barrett's Esophagus after Radiofrequency Ablation

Endoscopic endoluminal radiofrequency ablation (RFA) is a novel and promising modality for Barrett's esophagus (BE) treatment. Actually the only surveillance method after the ablation treatment is random biopsies throughout the whole treated area. Confocal laser endomicroscopy (CLE) is a new endoscopic imaging tool that permits high-resolution microscopic examination of the gastrointestinal tract. The technology has garnered increasing attention because of its ability to provide real-time "optical" biopsy specimens, with a very high sensitivity and specificity. This paper summarize the potential application of CLE in the surveillance of the reepithelialization of BE, after endoscopic RFA

Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer. Despite advances in therapy, more than 50% of patients have incurable disease at the time of presentation. This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients. Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom, the optimum management is not established. Self-expanding metal stents (SEMS) are a well-established palliation modality for dysphagia in such patients. Health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic or palliative intervention. To date, only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation. The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC. All Medline articles regarding HRQoL in patients with advanced EC, particularly those related to SEMS, were reviewed. In most studies, relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy. SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia, recurrent dysphagia and better HRQoL, although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions

Which stent stenosis of the esophagus which [Quale stent in quale stenosi dell'esofago].

Self expandable esophageal prosthesis today represent an effective palliative treatment in esophageal cancer and in cases of stenosis or fistula into the trachea or in the mediastinum, with a limited number of complications. Covered metal ones are preferable, while the plastic stents present a more difficult position and higher incidence of migration. Results in benign stenosis are less successful: their use is recommended only in selected cases. Further long-term prospective data are awaited before biodegradable stents can be recommended for the management of benign esophageal lesions

Hybrid patch-based and image-wide classification of confocal laser endomicroscopy images in Barrett\u2019s esophagus surveillance

Barrett's esophagus (BE) is a premalignant condition characterized by the replacement of normal squamous esophageal epithelium by metaplastic intestinal epithelium containing goblet cells. To be diagnosed and monitored, BE requires a thorough observation of epithelial macro- and microscopic changes. Confocal laser endomicroscopy (CLE) has recently revealed to be a useful technique for in vivo virtual histology for BE surveillance. We present a computer-based method for the automatic classification of gastric metaplasia (GM), intestinal metaplasia (IM) and neoplasia (NPL) on the basis of appearance features of confocal images. Comparing the automatic results with the histological gold standard, the proposed method classifies IM, GM, and NPL confocal images with accuracy comparable to human observer. Moreover, it increases the sensitivity and the specificity of CLE examinations, thus decreasing the number of biopsies needed for BE and neoplasia diagnosis