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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1701-1710
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1701
Appraisal of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic cysts
Somashekar G Krishna, Jeffery H Lee
Somashekar G Krishna, Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, OH 43210, United States
Jeffery H Lee, Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Conflict-of-interest statement: None of the authors have any potential conflicts (financial, professional, or personal) that are relevant to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeffrey H Lee, MD, MPH, FACG, FASGE, Professor, Director, Advanced Endoscopy Fellowship and Training, Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1466, Houston, TX 77030, United States. jefflee@mdanderson.org
Telephone: +1-713-7945073 Fax: +1-713-5634408
Received: May 30, 2015
Peer-review started: June 4, 2015
First decision: July 14, 2015
Revised: August 20, 2015
Accepted: October 23, 2015
Article in press: October 29, 2015
Published online: January 28, 2016
Processing time: 235 Days and 10.7 Hours
Abstract

Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Even though most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Current evaluation of suspicious cystic lesions includes a combination of radiologic imaging, endoscopic ultrasound (EUS) and cyst fluid analyses. Despite these attempts, precise diagnostic stratification among non-mucinous, mucinous, and malignant cystic lesions is often not possible until surgical resection. EUS-guided needle based confocal laser endomicroscopy (nCLE) for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. Though limited imaging data from 3 large clinical trials (INSPECT, DETECT and CONTACT) are currently the reference standard for nCLE imaging, nonetheless these have not been validated in large studies. The aim of this review article is to review the evolving role of EUS-guided nCLE in management of pancreatic cystic lesions in terms of its significance, adverse events, limitations, and implications.

Keywords: Pancreatic cyst; Needle-based confocal laser endomicroscopy; Endoscopic ultrasound; Intraductal papillary mucinous neoplasm; Mucinous cystadenoma; Serous cystadenoma; Pancreatic cancer

Core tip: Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Endoscopic ultrasound-guided confocal laser endomicroscopy for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. The feasibility of visualization at the microscopic level enables in differentiating cystic pancreatic lesions, but with certain challenges. In keeping with the gastroenterologist’s motto of ‘seeing is believing’, this technology is poised for continued and expanded research.