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Background and Aim: Current diagnostic modalities for indeterminate biliary strictures offer low accuracy. Probe-based confocal laser endomicroscopy (pCLE) permits microscopic assessment of mucosal structures by obtaining real-time highresolution images of the mucosal layers of the gastrointestinal tract. Previously, an interobserver study demonstrated poor to fair agreement even among experienced confocal endomicroscopy operators. Our objective was to assess interobserver agreement and diagnostic accuracy upon completion of a pCLE training session. Methods: Forty de-identified pCLE video clips of indeterminate biliary strictures were sent to five endoscopists at four tertiary care centers for scoring. Observers subsequently attended a teaching session by an expert pCLE user that included 20 training clips and rescored the same pCLE video clips, which were randomized and renumbered. Results: Pre-training interobserver agreement for all observers was 'fair' (: 0.31, P-value: <0.0001) and diagnostic accuracy was 72% (55-80%). Post-training interobserver agreement for all observers was 'substantial' (: 0.74, P-value: <0.0001) and diagnostic accuracy was 89% (80-95%). Using a paired t-test, we observed an increase of 17% (95% CI 7.6-26.4) in post-training diagnostic accuracy (t = 5.01, df = 4, P-value 0.007). Conclusions: Interobserver agreement and diagnostic accuracy improved after observers underwent training by an expert pCLE user with a specific sequence set. Users should participate in such training programs to maximize diagnostic accuracy of pCLE evaluation. [ABSTRACT FROM AUTHOR]

Background: Cryosurgery for prostate cancer is the ablation of the cancer by inducing a lethal freezing temperature (−40°C) to kill the cancer cells. This is now one of the optional curative treatments for localized prostate cancer patients. Methods: A third generation cryotherapy machine was used. An ultrathin 17 Fr cryoneedle was used to puncture the prostate gland transperineally under real-time transrectal ultrasound guidance. Cryogen gas, using argon, was used for active freezing and helium gas was used for active thawing. Thermoprobes were used to ensure the lethal temperature was reached. A urethral warmer device was necessary to reduce urethral damage. Foley catheterization was necessary for 2–3 days postoperatively. Results: Postoperative prostate specific antigen (PSA) level was monitored 3 monthly. Biochemical success (PSA < 0.4) can be achieved in most cases. Conclusion: This new cryoablation of prostate cancer can provide a minimally invasive option for localized prostate cancer patients. [ABSTRACT FROM AUTHOR]