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BACKGROUND depth ~ 55-70 µm). In Barrett's esophagus, adding pCLE to high-definition endoscopy nearly doubled neoplasia detection sensitivity versus standard protocols. For GIM, pooled sensitivity and specificity reached 97% and 94%. For colorectal lesions, sensitivity 81-91% and specificity 75-91% allowed in vivo characterization and fewer unnecessary resections. In IBD surveillance, pCLE identified more neoplasia with fewer biopsies (up to ~ 4.7-fold increase) and pooled sensitivity/specificity of 87-100%/90-94%. In indeterminate biliary strictures, pCLE integrated with ERCP/EUS improved accuracy and achieved negative predictive values up to 100%. Safety is favorable; risks relate mainly to fluorescein. Limitations include superficial penetration, narrow field of view, operator dependence, image-interpretation variability, procedure time, and high capital and per-case costs. Current guidelines view pCLE as an adjunct rather than routine standard. Emerging AI-assisted interpretation and molecular/ multispectral probes may standardize reads, expand indications, and improve yield. CONCLUSIONS: pCLE strengthens endoscopic decision-making by enabling immediate, near-histologic assessment, targeted sampling, and earlier therapy. Broader adoption hinges on standardized training, validated image criteria, multicenter randomized trials with health-economic endpoints, and integration of AI and molecular imaging to reduce variability and cost.
Ayyad et al. (2025) studied this question.