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The current issue of Gut contains a large randomised study by Hurlstone et al (see page 10.1136/gut.2007.131359) on the value of confocal laser microscopy (CLM) in improving the yield of biopsies in lesions stained positive by methylene blue in patients with longstanding ulcerative colitis (UC).1 This study follows another randomised study by the Mainz group, which, however, compared the traditional approach (conventional endoscopy with stepwise biopsies) with staining plus CLM2: in this German study, more neoplasias were found by staining plus CLM than in the control group, and it cannot be precisely determined whether this was due to staining—as shown by the same group before3—or to the addition of CLM. The concept, on which most of these imaging studies are based, includes “lesion finding” by staining (or perhaps other techniques such as narrow-band imaging) and “lesion characterisation” by another technique—for example, CLM, also called endoscopic histology. Such an approach, if shown to be valid, could finally have the consequence of biopsies only being performed on lesions positive on the lesion finding technique which are also positive on the lesion characterisation technique (eg, CLM), thus reducing the number of necessary biopsies. Such an approach, however, has not been tested as yet in a clinical scenario by means of a randomised study. A combination of two tests possibly serving both purposes (lesion finding and lesion characterisation) has recently been shown for autofluoresence and narrow-band imaging in patients with Barrett’s oesophagus.4 5
Let us examine a few general thoughts on study methodology, before we go on. Methodology of imaging studies is often difficult, and several approaches compete. In contrast …
Competing interests: None declared