Original articleClinical endoscopyExperienced versus inexperienced confocal endoscopists in the diagnosis of gastric adenocarcinoma and intestinal metaplasia on confocal images
Section snippets
Equipment
A confocal laser endomicroscope (Pentax, Tokyo, Japan) was used for the study. The instrument enables CLE in addition to standard video endoscopy. Confocal images could be generated simultaneously with endoscopic images. In laser scanning confocal microscopy, focal laser illumination is combined with pinhole limited detection to geometrically reject out-of-focus light. Each resulting image is an optical section representing approximately 1 focal plane within the specimen. The optical slice
Results
Six gastric cancer resection specimens were used for the ex vivo study. The confocal images obtained from the first 3 resection specimens were used for the consensus meetings to determine the diagnostic criteria for gastric cancer. The confocal images from the next 3 resection specimens were used for the image assessment.
Thirty patients were recruited for the in vivo study. The confocal images from the first 10 patients were used in the consensus meetings. The confocal images from the next 20
Discussion
This study suggests that when CLE is used by endoscopists with a specialized interest in confocal imaging, it is an accurate method for the diagnosis of GIM and gastric cancer, and experts with previous CLE experience perform better than nonexperts for the diagnosis of GIM on CLE images. After receiving training in the interpretation of confocal images, although inexperienced CLE endoscopists perform as well as experienced CLE endoscopists in the diagnosis of gastric cancer on CLE images, the
Acknowledgments
We thank Yeo Lei Pheng and Jennie Wong for their assistance.
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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.