AIM:To compare the interpretation of probe-based confocal laser endomicroscopy(p CLE)findings between endoscopists and gastrointestinal(GI)-pathologists.METHODS:All p CLE procedures were undertaken and the endoscopist rendered assessment.The same p CLE videos were then viewed offline by an expert GI pathologist.Histopathology was considered the gold standard for definitive diagnosis.The sensitivity,specificity and accuracy for diagnosis of dysplastic/neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for p CLE findings were analyzed.RESULTS:Of the 66 included patients,40(60.6%)had lesions in the esophagus,7(10.6%)in the stomach,15(22.7%)in the biliary tract,3(4.5%)in the ampulla and 1(1.5%)in the colon.The overall sensitivity,specificity and accuracy for diagnosing dysplastic/neoplastic lesions using p CLE were higher for endoscopists than pathologist at 87.0%vs 69.6%,80.0%vs 40.0%and 84.8%vs 60.6%(P=0.0003),respectively.Area under the ROC curve(AUC)was greater for endoscopists than the pathologist(0.83 vs 0.55,P=0.0001).Overall agreement between endoscopists and pathologist was moderate for all GI lesions(K=0.43;95%CI:0.26-0.61),luminal lesions(K=0.40;95%CI:0.20-0.60)and those of dysplastic/neoplastic pathology(K=0.55;95%CI:0.37-0.72),the agreement was poor for benign(K=0.13;95%CI:-0.097-0.36)and pancreaticobiliary lesions(K=0.19;95%CI:-0.26-0.63).CONCLUSION:There is a wide discrepancy in the interpretation of p CLE findings between endoscopists and pathologist,particularly for benign and malignant pancreaticobiliary lesions.Further studies are needed to identify the cause of this poor agreement. AIM: To compare the interpretation of probe-based confocal laser endomicroscopy (p CLE) findings between endoscopists and gastrointestinal (GI) -pathologists. METHODS: All p CLE procedures were carried and the endoscopist rendered assessment. The same p CLE videos were then viewed offline by an expert GI pathologist. Histopathology was considered the gold standard for definitive diagnosis. sensitivity, specificity and accuracy for diagnosis of dysplastic / neoplastic GI lesions and interobserver agreement between endoscopists and experienced gastrointestinal pathologist for pUR findings were analyzed .RESULTS: Of the 66 included patients, 40 (60.6%) had lesions in the esophagus, 7 (10.6%) in the stomach, 15 (22.7%) in the biliary tract, 3 the colon.The overall sensitivity, specificity and accuracy for diagnosing dysplastic / neoplastic lesions using p CLE were higher for endoscopists than pathologist at 87.0% vs 69.6%, 80.0% vs 40.0% and 84.8% vs 60.6% (P = 0.0003), respectively . Overall uniformity between both endoscopists and pathologist was moderate for all GI lesions (K = 0.43; 95% CI: 0.26-0.61). The area under the ROC curve (AUC) was greater for endoscopists than the pathologist (0.83 vs 0.55, 95% CI: 0.20-0.60) and those of dysplastic / neoplastic pathology (K = 0.55; 95% CI: 0.37-0.72), the agreement was poor for benign (K = 0.13; 95% CI: CI: -0.097-0.36) and pancreaticobiliary lesions (K = 0.19; 95% CI: -0.26-0.63). CONCLUSION: There is a wide discrepancy in the interpretation of p CLE findings between endoscopists and pathologist, particularly for benign and malignant pancreaticobiliary lesions.Further studies are needed to identify the cause of this poor agreement.