From Our 2008 Archives

New Technology Speeds GI Disease Diagnosis

SUNDAY, May 18 (HealthDay News) — A real-time microscopic technique called confocal laser endomicroscopy (CLE) could lead to earlier diagnosis and treatment of gastrointestinal disorders such as cancer, reflux disease, and inflammatory bowel disease.

That's the conclusion of several studies to be presented May 18 at the Digestive Disease Week conference in San Diego.

CLE, which uses a tiny microscope at the end of an endoscope, effectively and immediately identifies suspicious patterns and precancerous cells and may eliminate the need for biopsies to diagnose gastrointestinal (GI) conditions, according to experts.

"Up until now, determining the condition of a patient required days or even weeks while patients waited for diagnosis; further, it has been difficult to detect subtle precancerous lesions or even areas within a large lesion, often leading to time-consuming and labor-intensive procedures as well as uncertainty about missing something important," Dr. Pankaj J. Pasricha, professor of medicine, gastroenterology and hepatology at Stanford University School of Medicine, said in a prepared statement.

"New techniques such as those discussed (at the conference) will change the way we diagnose patients, allowing us to treat them more accurately, quickly and appropriately," Pasricha said.

In one study, Johns Hopkins University School of Medicine researchers found that CLE provided an accuracy rate of 91 percent in the upper GI tract and 93 percent in the lower GI tract.

"This is a very promising technique for real-time microscopic imaging of the gastrointestinal tract," study author Dr. Kerry B. Dunbar, a fellow in the division of gastroenterology and hepatology, said in a prepared statement. "Previously, it took a few days or a week to find out a diagnosis, because we'd have to take photos and then do a mucosal biopsy. But with CLE, we can see what's going on at the time of the endoscopy and then diagnose and treat patients immediately, instead of waiting a week or more."

In another study, Dunbar and colleagues concluded that CLE was as effective as a biopsy in identifying precancerous cells in people with Barrett's esophagus, a condition that can often lead to esophageal cancer.

These findings suggest that use of CLE could reduce the number of biopsies of abnormal tissue, because doctors would be able to immediately detect the presence of precancerous cells. Patients with Barrett's esophagus can require several tissue biopsies, which are expensive, invasive and can cause bleeding, the researchers said.

The results suggest that CLE "improves diagnosis of Barrett's esophagus, and offers great promise for reducing the number of biopsies needed to look for dysplasia in the esophagus," Dunbar said.

A third study found that CLE is highly accurate in immediately distinguishing benign from precancerous polyps of the colon. Using CLE, researchers from the Mayo Clinic, in Jacksonville, Fla., were 89 percent accurate in determining the sensitivity and specificity of colon polyps. They were able to identify small benign polyps 98 percent of the time. Normally, these polyps would be removed.

"This technique will fundamentally change how the two fields (endoscopy and pathology) interact," study author Dr. Anna M. Buchner said in a prepared statement. "This procedure allows us to become endopathologists, and the result is that we will be able to better manage patients with gastrointestinal disorders."

— Robert Preidt

SOURCE: Digestive Disease Week, news release, May 18, 2008

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