Needle-based confocal endomicroscopy in the discrimination of mucinous from non-mucinous pancreatic cystic lesions

BACKGROUND Pancreatic cystic lesions(PCLs)are considered a precursor of pancreatic cancer.Needle-based confocal endomicroscopy(nCLE)is an imaging technique that enables visualization of the mucosal layer to a micron resolution.Its application has demonstrated promising results in the distinction of PCLs.This study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration(EUS-FNA)to distinguish mucinous from non-mucinous lesions.AIM To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous lesions.METHODS Patients who required EUS-FNA between 2015 and 2017 were enrolled prospectively.During EUS-FNA,confocal imaging,analyses of the tumor markers carcinoembryonic antigen and amylase,and cytologic examination were conducted.All patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance imaging.nCLE videos were independently reviewed by 6 observers to reach a final diagnosis(mucinous vs non-mucinous)based on criteria derived from previous studies;if there was disagreement>20%,a final diagnosis was discussed after consensus re-evaluation.The sensitivity,specificity,and accuracy of nCLE were calculated.Adverse events were recorded.RESULTS Fifty-nine patients were included in this study.Final diagnoses were derived from surgery in 10 patients,cytology in 13,and imaging and multidisciplinary team review in 36.Three patients were excluded from final diagnosis due to problems with nCLE acquisition.Fifty-six patients were included in the final analysis.The sensitivity,specificity,and accuracy of nCLE were 80%[95%confidence interval(CI):65-90],100%(95%CI:72-100),and 84%(95%CI:72-93),respectively.Postprocedure acute pancreatitis occurred in 5%.CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.

Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes

In recent years,the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms,probably due to the widespread use of high-resolution imaging techniques.However,there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound(EUS)in the diagnostic work up.When noninvasive imaging tests(transabdominal ultrasound,computed tomography or magnetic resonance cholangiopancreatography)fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent,the probability of having biliary disease is considered low.In this setting,using EUS,the presence of pathologic findings(choledocholithiasis,strictures,chronic pancreatitis,ampullary or pancreatic tumors,cholangiocarcinoma),not always with a benign course,has been observed.The aim of this review has been to evaluate the prevalence of disease among nonjaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield.Data point out to a promising role of EUS in the identification of a potential biliary pathology.EUS is a low invasive technique,with high accuracy,that could play a double cost-effective role:identifying pathologic conditions with dismal prognosis,in asymptomatic patients with negative prior imaging tests,and excluding pathologic conditions and further follow-up in healthy subjects.