A modified Delphi process with consistent literature review was used to establish the consensus in four steps. A first draft of statements was established by the different group leaders (main authors), based on an exhaustive review of the literature. After a forum discussion, all participants had the opportunity to vote twice via an individual electronic vote, followed by group iteration. For each vote and each statement, the participants provided their level of agreement and the grade of clinical evidence.

Statements like "CLE is more accurate than ERCP with brush cytology and/or forceps biopsy in determining malignant or benign strictures, using established criteria" (Agreement: 87%, Evidence: 88%) were voted on and justified by the grade of evidence.

The authors concluded: "CLE should be used to enhance the diagnostic arsenal in the evaluation of BE, biliary strictures, colorectal lesions and IBD, by providing microscopic information which improves the diagnostic performance of the physician. In order to actually implement the technology in clinical routine, and to ensure good practice, standardized initial and continuing institutional training programs should be established."