Confocal Laser Endomicroscopy: Real-Time Histology at the Fingertips: A Comprehensive Review of Current Applications of Endomicroscopy in Barrett Esophagus, Inflammatory Bowel Disease, and Colorectal Lesions

Confocal laser endomicroscopy (CLE) is an innovative diagnostic modality that facilitates real-time in vivo optical biopsies of various tissues within luminal and ductal structures. Since its introduction in 2004, the application of this tool has broadened from diagnostic purposes to encompass management and prognostic evaluation in fields such as gastroenterology, neurosurgery, urology, and dermatology. This comprehensive review examines the current applications of endomicroscopy in Barrett's esophagus (BE), inflammatory bowel disease (IBD), and colorectal lesions. Evidence from the literature suggests that CLE offers a potential solution to the diagnostic limitations associated with white-light endoscopy and histology. With a diagnostic accuracy nearly equivalent to that of histology, CLE is emerging as a promising tool to mitigate the delays related to awaiting histology results for clinical and therapeutic decision-making. However, its use is mainly as a complementary diagnostic method rather than an alternative to histopathology or other ancillary studies. Nevertheless, its widespread adoption remains limited, and further research is necessary to ascertain its overall benefits and cost implications of integrating it into patient care.