Michael B Wallace

The learning curve of in vivo probe-based confocal laser endomicroscopy for prediction of colorectal neoplasia.

BACKGROUNDnProbe-based confocal laser endomicroscopy (pCLE) is an emerging tool for in vivo imaging of the GI tract that requires the endoscopist to interpret microscopic images. The learning curve for interpretation of pCLE images is unknown.nnnOBJECTIVEnTo examine the learning curve of correctly identifying benign and neoplastic colorectal lesions by using pCLE and to evaluate the learning curve of obtaining high-quality images.nnnDESIGNnProspective, double-blind review of pCLE images of 76 colorectal lesions by using corresponding polypectomies as the reference standard. A training set of 20 images with known histology was first reviewed to standardize image interpretation, followed by blinded review of 76 unknown images.nnnSETTINGnEleven endoscopists from 3 different endoscopy centers evaluated the images obtained by 1 endoscopist using the high-definition confocal probe.nnnPATIENTSnPatients undergoing screening and surveillance colonoscopies.nnnINTERVENTIONnIntravenous fluorescein pCLE imaging of colorectal lesions followed by polypectomies.nnnMAIN OUTCOME MEASUREMENTSnAccuracy of image interpretation with constructing learning curve for pCLE image interpretation and acquisition.nnnRESULTSnOf the 76 colorectal lesions, 51 (67%) were neoplastic and 25 (33%) were benign, based on histopathology. Accuracy for the overall group was 63% for lesions 1 to 20, 64% for lesions 21 to 40, 79% for lesions 41 to 60, and 86% for lesions 61 to 76. The ability to obtain high-quality images was stable over the 76 cases.nnnLIMITATIONSnSmall sample size and use of offline video sequences.nnnCONCLUSIONSnAccurate interpretation of pCLE images for predicting neoplastic lesions can be learned rapidly by a wide range of GI specialists. Furthermore, the ability to acquire high-quality pCLE images is also quickly learned.

Diagnostic Meta-Analysis: Case Study in Gastroenterology

Meta-analysis refers to the use of statistical tools to combine and compare the results of multiple studies on particular outcomes on interest. Use of meta-analysis in the medical literature, including the field of gastroenterology, has been increasing. Conducting high-quality meta-analysis can be challenging. Similarly understanding published meta-analyses can be difficult. In this chapter, we will present several case studies on meta-analyses in gastroenterology. We will use these studies to shed light on several key factors in meta-analyses. These factors include the importance of choosing the appropriate inclusion and exclusion criteria, deciding on the best meta-meter of interest, recognizing and dealing with duplicate cohorts, and using direct and indirect comparisons. Our goal is to show how meta-analyses can be great tools for providing evidence-based results that can have a significant impact on clinical practice in the field of gastroenterology.