***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS Confocal laser endomicroscopy allows subsurface analysis of the intestinal mucosa and in vivo histology during ongoing endoscopy . Here , we have applied this technique to the in vivo diagnosis of Barrett 's epithelium and associated neoplasia . METHODS Fluorescein-aided endomicroscopy was performed by applying the endomicroscope over the whole columnar-lined lower esophagus . Images obtained within 1 cm of the columnar-lined lower esophagus were stored digitally and a targeted biopsy examination or endoscopic mucosal resection of the examined areas was performed . In vivo histology was compared with the histologic specimens . All digitally stored images were re-assessed by a blinded investigator by the confocal Barrett classification system to predict histology . Intraobserver and interobserver variations of the involved endoscopists were evaluated by using kappa statistics . RESULTS Endomicroscopy allowed distinguishing between different types of epithelial cells and detected cellular and vascular changes in Barrett 's epithelium at high resolution during ongoing endoscopy in 63 patients . Barrett 's esophagus and associated neoplasia could be predicted with a sensitivity of 98.1 % and 92.9 % and a specificity of 94.1 % and 98.4 % , respectively ( accuracy , 96.8 % and 97.4 % ) . The mean kappa value for interobserver agreement for the prediction of histopathological diagnosis was .843 , whereas the intraobserver agreement showed a mean kappa value of .892 . CONCLUSIONS Fluorescence-aided endomicroscopy of Barrett 's esophagus allows in vivo histology of the mucosal layer during ongoing endoscopy . Gastric and Barrett 's epithelium and Barrett's-associated neoplastic changes can be diagnosed with high accuracy . Thus , endomicroscopy may be helpful in the management of patients with Barrett 's esophagus Objectives Loss of intestinal barrier function plays an important role in the pathogenesis of inflammatory bowel disease ( IBD ) . Shedding of intestinal epithelial cells is a potential cause of barrier loss during inflammation . The objectives of the study were ( 1 ) to determine whether cell shedding and barrier loss in humans can be detected by confocal endomicroscopy and ( 2 ) whether these parameters predict relapse of IBD . Methods Confocal endomicroscopy was performed in IBD and control patients using intravenous fluorescein to determine the relationship between cell shedding and local barrier dysfunction . A grading system based on appearances at confocal endomicroscopy in humans was devised and used to predict relapse in a prospect i ve pilot study of 47 patients with ulcerative colitis and 11 patients with Crohn 's disease . Results Confocal endomicroscopy in humans detected shedding epithelial cells and local barrier defects as plumes of fluorescein effluxing through the epithelium . Mouse experiments demonstrated inward flow through some leakage-associated shedding events , which was increased when luminal osmolarity was decreased . In IBD patients in clinical remission , increased cell shedding with fluorescein leakage was associated with subsequent relapse within 12 months after endomicroscopic examination ( p<0.001 ) . The sensitivity , specificity and accuracy for the grading system to predict a flare were 62.5 % ( 95 % CI 40.8 % to 80.4 % ) , 91.2 % ( 95 % CI 75.2 to 97.7 ) and 79 % ( 95 % CI 57.7 to 95.5 ) , respectively . Conclusions Cell shedding and barrier loss detected by confocal endomicroscopy predicts relapse of IBD and has potential as a diagnostic tool for the management of the disease OBJECTIVES : Epithelial gaps result ing from intestinal cell extrusions can be visualized with confocal laser endomicroscopy ( CLE ) during colonoscopy and increased in normal-appearing terminal ileum of inflammatory bowel disease ( IBD ) patients . Cell-shedding events on CLE were found to be predictive of disease relapse . The aim of this study was to assess the prognostic value of epithelial gap densities for major clinical events ( hospitalization or surgery ) in follow-up . METHODS : We prospect ively followed IBD patients undergoing colonoscopy with probe-based CLE ( pCLE )  for clinical events including symptom flares , medication changes , hospitalization , or surgery . Survival analysis methods were used to compare event times for the composite outcome of hospitalization or surgery using log-rank tests and Cox proportional hazards models . We also examined the relationship of gap density with IBD flares , need for anti-tumor necrosis factor therapy , disease duration , gender and endoscopic disease severity , and location . RESULTS : A total of 21 Crohn 's disease and 20 ulcerative colitis patients with a median follow-up of 14 ( 11–31 ) months were studied . Patients with elevated gap density were at significantly higher risk for hospitalization or surgery ( log-rank test P=0.02 ) . Gap density was a significant predictor for risk of major events , with a hazard ratio of 1.10 ( 95 % confidence interval=1.01 , 1.20 ) associated with each increase of 1 % in gap density . Gap density was also correlated with IBD disease duration ( Spearman 's correlation coefficient rho=0.44 , P=0.004 ) , and was higher in male patients ( 9.0 vs. 3.6 gaps per 100 cells , P=0.038 ) . CONCLUSIONS : Increased epithelial gaps in the small intestine as determined by pCLE are a predictor for future hospitalization or surgery in IBD patients BACKGROUND Confocal endomicroscopy is a newly developed endoscopic imaging technology that produces 1000-fold magnification cross-sectional images of the GI surface and subsurface tissue during routine endoscopy . The gastric pit patterns identified by confocal endomicroscopy and correlation with histopathologic examination have not yet been established . OBJECTIVE Our purpose was to explore the appearance of various kinds of gastric pits and clarify the relationship between gastric pit patterns and the histopathologic findings . DESIGN Descriptive study . SETTING Qilu Hospital , Sh and ong University , Jinan , China . PATIENTS A total of 132 consecutive patients underwent confocal endomicroscopy after 7 healthy volunteers had been examined in vivo and 10 sample s resected from 10 patients with gastric cancer had been examined ex vivo by use of confocal endomicroscopy .  The confocal images obtained from the 132 patients were compared with the histopathologic findings of the biopsy specimens from the corresponding confocal imaging sites in a prospect i ve and blinded fashion . MAIN OUTCOME MEASUREMENTS The relationship between the pit patterns and the histopathologic findings . RESULTS Gastric pit patterns were classified into 7 types . Normal mucosa with fundic gl and s mainly showed type A ( round pits ) , and corporal mucosa with histologic gastritis showed type B ( noncontinuous short rod-like ) ; normal mucosa with pyloric gl and s mainly showed type C ( continuous short rod-like ) , and antral mucosa with histologic gastritis showed type D ( elongated and tortuous branch-like ) . Goblet cells were easily distinguished by confocal endomicroscopy in intestinal metaplasia mucosa , which showed type F. The sensitivity and specificity of the type E pattern for predicting gastric atrophy were 83.6 % and 99.6 % , respectively . Corresponding values of the type G pattern for predicting gastric cancer were 90.0 % and 99.4 % . LIMITATIONS No data on interobserver and intraobserver variability . CONCLUSIONS The patterns of gastric pits identified by confocal endomicroscopy correlate well with the histopathologic findings . Confocal endomicroscopy may prove useful in predicting histopathologic diagnoses during routine endoscopic procedures Background Patients with ulcerative colitis and Crohn 's colitis have increased risk of colorectal cancer . Current screening endoscopy protocol s based on white light endoscopy ( WLE ) and r and om biopsies are laborious and of uncertain sensitivity . Novel endoscopic techniques include chromoendoscopy ( CE ) and confocal laser endomicroscopy ( CLE ) . Aim The aim was to compare WLE and CE for the detection of intraepithelial neoplasia ( IEN ) . Furthermore , we analysed the sensitivity and specificity of CE and CLE for the diagnosis of IEN . Methods The cohort consisted of 30 patients examined by WLE , CE with 0.4 % indigocarmine , and by a CLE system Pentax EC-3870CIFK during one examination . Additional 15 patients were examined by conventional protocol only .  R and om biopsies and biopsies from all suspicious lesions were taken . We compared the number of IENs detected by WLE and CE and analysed the predictive values of CE and CLE for the histology diagnosis . Results There were 1584 r and om biopsies ( 35.2 per patient ) taken . There were 78 targeted biopsies ( 1.7 per patient ) taken in 24 of 45 patients examined by WLE and an additional 36 biopsies in 16 of 30 patients examined by CE ( 1.17 additional per patient ) . There were no IENs found on r and om biopsies versus six low- grade or high- grade IENs in four patients ( two detected by WLE , four additional by CE ) from targeted biopsies , P=0.02 . A total of 100 suspicious lesions were detected and analysed by CE and histology . CLE could not examine 32 of 100 lesions ( two of 30 flat vs. 30 of 70 pedunculated lesions , P=0.0002 , odds ratio 10.5 ) . The sensitivity of CE/CLE for low- grade or high- grade IEN was 100/100 % , the specificity 96.8/98.4 % , positive predictive value was 62.5/66.7 % and negative predictive value was 100/100 % . Conclusion Targeted biopsies are superior to r and om biopsies in the screening of IEN in patients with inflammatory bowel disease . CE increases the diagnostic yield of WLE . In our study CLE did not provide additional clinical benefits Background : Increased cell shedding with gap formation and local barrier dysfunction can be identified endomicroscopically in the terminal ileum of patients with inflammatory bowel disease . We aim to evaluate whether these changes are also present in the duodenum of patients with inflammatory bowel disease . Methods : Fifteen patients with Crohn 's disease ( CD ) , 10 patients with ulcerative colitis ( UC ) , and 10 controls underwent fluorescein-aided confocal laser endomicroscopy ( CLE ) . CLE was performed on macroscopically normal antral and duodenal ( D1 , D2 , D3 , D4 ) mucosa . Representative CLE images were prospect ively analyzed . Images were scored for the number of epithelial gaps , cell shedding , and the degree of fluorescein leakage into the intestinal lumen . Results : Both CD and UC patients had significantly more epithelial gaps , epithelial cell shedding , and leakage of fluorescein into the duodenal lumen than controls . The degree of cell shedding and epithelial gap formation was similar in CD and UC patients . In all cases , macroscopic endoscopic appearances of the duodenum were normal , and conventional histological analysis showed a mild nonspecific duodenitis in 7 of 15 patients with CD . Patients with UC had a histologically normal duodenum . Gap formation , cell shedding , and fluorescein leakage was similar in CD with active compared with inactive disease , except for D2 shedding . Conclusions : CLE can detect epithelial damage and barrier loss in the duodenum of CD and UC patients that is not apparent on conventional endoscopy or histology BACKGROUND The diagnosis of pancreatic cystic neoplasms ( PCNs ) , which now depends on morphology , cytology , and fluid analysis , is still challenging . A novel confocal laser endomicroscopy probe that can be inserted through a 19-gauge FNA needle allows needle-based confocal laser endomicroscopy ( nCLE ) , and the feasibility of nCLE has been reported in PCNs . The combination of cystoscopy by using a through-the-needle fiberoptic probe in combination with nCLE under EUS guidance may improve the diagnosis of PCNs . OBJECTIVE To assess the feasibility , safety , and diagnostic yield of the combination of cystoscopy and nCLE in the clinical diagnosis of PCNs . DESIGN A prospect i ve feasibility study . SETTING An academic tertiary referral center . PATIENTS Thirty patients with PCNs . INTERVENTIONS EUS-guided dual through-the-needle imaging ( cystoscopy and nCLE ) for PCNs . MAIN OUTCOME MEASUREMENTS Technical feasibility and safety . Associations of cystoscopy and nCLE findings with clinical diagnosis of PCNs . RESULTS The procedure was technically successful with the exception of 1 probe exchange failure . In 2 patients ( 7 % ) , postprocedure pancreatitis developed . Specific features associated with the clinical diagnosis of mucinous cysts were identified : mucin on cystoscopy and papillary projections and dark rings on nC 
    Output:
    
CLE demonstrated high sensitivity and specificity in the detection of dysplasia in Barrett 's esophagus , gastric neoplasms and polyps , colorectal cancers in inflammatory bowel disease , malignant pancreatobiliary strictures , and pancreatic cysts .