Kenneth K Wang1, David L Carr-Locke2, Satish K Singh3, Helmut Neumann4, Helga Bertani5, Jean-Paul Galmiche6, Razvan I Arsenescu7, Fabrice Caillol8, Kenneth J Chang9, Stanislas Chaussade10, Emmanuel Coron6, Guido Costamagna11, Aldona Dlugosz12, S Ian Gan13, Marc Giovannini8, Frank G Gress14, Oleh Haluszka15, Khek Y Ho16, Michel Kahaleh17, Vani J Konda18, Frederic Prat10, Raj J Shah19, Prateek Sharma20, Adam Slivka21, Herbert C Wolfsen22, Alvin Zfass23. 1. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. 2. Division of Digestive Diseases, Beth Israel Medical Center, New York City, NY, USA. 3. Department of Medicine, Boston University School of Medicine, Boston, MA, USA. 4. The Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany. 5. Endoscopy Unit, Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy. 6. Division of Gastroenterology and Hepatology, Nantes CHU, Rouen, France. 7. Ohio State University, Columbus, OH, USA. 8. Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France. 9. H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA. 10. Division of Gastroenterology, Hopital Cochin and Paris-Descartes University, Paris, France. 11. Digestive Endoscopy Unit, Catholic University, Roma, Italy. 12. Karolinska Institutet, Department of Medicine, Division of Gastroenterology and Hepatology, Karolinska University Hospital, Stockholm, Sweden. 13. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA. 14. Division of Digestive and Liver disease, Columbia University Medical Center, New York City, NY, USA. 15. Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA. 16. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 17. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, NY, USA. 18. Center for Endoscopic Research and Therapeutics, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA. 19. University of Colorado School of Medicine, Aurora, CO, USA. 20. Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, MI, USA ; Department of Gastroenterology and Hepatology, The University of Kansas Medical Center, Kansas City, KS, USA. 21. Division of Gastroenterology & Hepatology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 22. Mayo Clinic, Jacksonville, FL, USA. 23. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
Abstract
BACKGROUND: Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training. OBJECTIVE: This study aimed to provide guidance on the standardisation of its practice and training in Barrett's oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases. METHODS: Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%. RESULTS: Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence. CONCLUSION: pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
BACKGROUND: Probe-based confocal laser endomicroscopy (pCLE) provides microscopic imaging during an endoscopic procedure. Its introduction as a standard modality in gastroenterology has brought significant progress in management strategies, affecting many aspects of clinical care and requiring standardisation of practice and training. OBJECTIVE: This study aimed to provide guidance on the standardisation of its practice and training in Barrett's oesophagus, biliary strictures, colorectal lesions and inflammatory bowel diseases. METHODS: Initial statements were developed by five group leaders, based on the available clinical evidence. These statements were then voted and edited by the 26 participants, using a modified Delphi approach. After two rounds of votes, statements were validated if the threshold of agreement was higher than 75%. RESULTS: Twenty-six experts participated and, among a total of 77 statements, 61 were adopted (79%) and 16 were rejected (21%). The adoption of each statement was justified by the grade of evidence. CONCLUSION: pCLE should be used to enhance the diagnostic arsenal in the evaluation of these indications, by providing microscopic information which improves the diagnostic performance of the physician. In order actually to implement this technology in the clinical routine, and to ensure good practice, standardised initial and continuing institutional training programmes should be established.
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