Meta-analysis of confocal laser endomicroscopy for the detection of colorectal neoplasia

Aim Confocal laser endomicroscopy (CLE) is a recently developed technique used to image colorectal neoplasia. Trials have shown varied results when it is compared with conventional colonoscopy. A meta‐analysis was performed to determine the diagnostic accuracy of CLE in the detection of colorectal neoplasia. Method A search was performed for studies assessing the accuracy of CLE in colorectal neoplasia. Studies comparing CLE diagnostic accuracy with conventional endoscopy in the detection of colorectal neoplasia were included. Exclusion criteria included case reports or case series, reviews, duplicate reports or insufficient data in the paper. Seventy‐eight titles came up in the initial search and six studies were selected. These were subjected to a meta‐analysis. In all, 284 patients with 1030 lesions were included. Each patient underwent conventional colonoscopy and CLE. Per‐lesion sensitivity and specificity with 95% CI were calculated. Results In the individual studies, the sensitivity ranged from 33.3% to 100% and specificity from 71.6% to 99.4%. The weighted and total pooled result (random effects model) for sensitivity was 81% (95% CI 77–85) and for specificity was 88% (95% CI 85–90). The area under the weighted symmetric summary receiver operating curve was 0.9186. In the endoscope‐based CLE subgroup, the sensitivity was 82% (95% CI 69–91) and specificity was 94% (95% CI 91–96). In the probe‐based CLE subgroup, the sensitivity was 81% (95% CI 76–85) and the specificity was 75% (95% CI 69–81). Conclusion CLE, using either the endoscope‐based CLE or probe‐based CLE technique, has high sensitivity and specificity. It could therefore be considered as an alternative endoscopic method to distinguish neoplastic from non‐neoplastic lesions.