Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis

Table 4

Summary of the studies evaluating CLE in biliary disease screening and diagnosis (all “per patient” analysis).

Author and year	Country		Mean age (yr)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)	Main findings
Meining et al. 2008 [107]	Germany	14 patients	61.3	83	88	/	/	86	p-CLE considerably increases sensitivity for the detection of biliary neoplasia and therefore represents a promising diagnostic approach.
Giovannini et al. 2011 [108]	France	37 patients	62.3	83	75	n/a	n/a	86	Intrabiliary pCLE is feasible.
Meining et al. 2011 [109]	Germany; USA	89 patients	62.8	98	67	71	97	81	p-CLE provides reliable microscopic examination and has excellent sensitivity and NPV with significantly higher accuracy of ERCP and pCLE compared with ERCP with tissue acquisition.
Meining et al. 2012 [110]	Germany; USA	47 and 42 patients	63.2; 63	97	33	80	80	n/a	The Miami Classification enables a structured, uniform, and reproducible description of pancreaticobiliary pCLE.
Shieh et al. 2012 [2]	USA	10 patients	56.9	n/a	n/a	n/a	n/a	n/a	pCLE of the CBD via the GastroFlex miniprobe is feasible and may offer improved image quality over the standard CholangioFlex probe.
Caillol et al. 2013 [111]	France; USA	60 patients	62.2	96.3	75.7	76.5	96.2	85	The Paris Classification improve the accuracy of pCLE for diagnosing benign inflammatory strictures.
Caillol et al. 2013 [112]	France	54 patients	66	88	83	n/a	n/a	87	Inflammation from prestenting procedures interferes with pCLE diagnosis of the bile duct lesions.
Heif et al. 2013 [113]	USA	15 patients	54	100	61.1	22.2	100	n/a	pCLE may have a high sensitivity and negative predictive value to exclude neoplasia in patients with PSC and DS.
Caillol et al. 2015 [114]	France	61 patients	67	88	79	92	69	85	The addition of a pCLE procedure in the diagnostic histologic examination of a biliary stricture permits a significant increase in diagnostic reliability and allows for a VPN of 100%.
Slivka et al. 2015 [115]	USA; Italy; France	112 patients	64.5	89	71	93	82	88	pCLE provided a more accurate and sensitive diagnosis of cholangiocarcinoma compared with tissue sampling alone.

stands for the number of patients enrolled in the study; pCLE, probe-based confocal laser endomicroscopy; CLE, confocal laser endomicroscopy; PPV, positive predictive value; NPV, negative predictive value; PSC, primary sclerosing cholangitis; DS, dominant biliary stricture; and CBD, common bile duct.