In summary, the prediction of neoplasia and benign lesions based on the pCLE imaging has a relatively high diagnostic accuracy as compared to histology analysis. This novel technique has the potential to avoid unnecessary polypectomy and biopsy and can lead to real-time management decisions. Lesions that are determined to be benign could potentially be left untreated once the confocal diagnosis is made, thus reducing risks and complications of unnecessary procedures. In theory, small, low-grade neoplastic polyps could also be diagnosed definitively by pCLE, without the need for histological confirmation and its associated cost and delays. Further improvement of the probes as well as additional improvement in our diagnostic capabilities with standardization of confocal images will be crucial in development of confocal microscopy. Future studies should also aim to combine confocal laser endoscopy and virtual chromoendoscopy in evaluation of colonic lesions during endoscopy. A combination of these two techniques will likely increase overall in vivo effectiveness diagnosing neoplastic lesions. Therefore, new trials on confocal probe-based system and virtual chromoendoscopy in evaluation of colonic lesions are warranted and ongoing.