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Bye-Bye Unnecessary Biopsies

New Technology CLE Could Lead to Earlier Diagnosis and Treatment of GI Diseases

CLE Reduces Unnecessary Biopsies continued...

As a result, recommendations call for patients to come in every one to three years for random tissue biopsies, which are invasive and can cause bleeding.

The study involved 36 patients. Fifteen were referred by their doctors because of high-grade dysplasia. Twenty-one patients had previously diagnosed Barrett's esophagus and were coming in for their regular surveillance biopsy. All underwent standard endoscopy plus tissue biopsy as well as CLE.

"In the group with high-grade dysplasia that were really worried about, CLE found all the areas of dysplasia that the endoscope did, and we had to biopsy much less tissue," Dunbar says.

In the patients with previously diagnosed Barrett's esophagus, "CLE allowed investigators to take biopsies only of areas that looked suspicious, instead of performing many unnecessary random biopsies," she says.

Additionally, CLE "may allow us to detect and treat early cancers or high-grade dysplasia in Barrett's esophagus patients at the same visit," Dunbar says.

CLE Spots Benign Polyps

A third study found that CLE is highly accurate in distinguishing benign from precancerous polyps of the colon.

Researchers at the Mayo Clinic in Jacksonville studied about 50 people. All got CLE as well as a traditional colonoscopy with removal of any polyps.

Compared with the gold standard -- the pathologist's determination of whether a polyp was benign or cancerous -- CLE had an overall accuracy of 90%.

More importantly, CLE was able to identify small benign polyps that had virtually no chance of ever turning cancerous in 98% of cases, says researcher Michael Wallace, MD, a professor of medicine at Mayo.

"This is important because normally these polyps would be removed. With CLE, we can avoid removing benign polyps -- which is less expensive, more efficient, and safer," he tells WebMD.

There are two FDA-approved CLE scopes, according to Wallace: the Optiscan/Pentax and Mauna Kea Technologies' Cellvizio.

Dunbar says that so far, the procedure is available at few medical centers, such as Johns Hopkins, or for people enrolled in a clinical trial. But she thinks that will change as more people are trained and more sites purchase the equipment.

"It's slowly catching on," Dunbar says.

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