Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

  • Do Han Kim (Universidad Francisco Marroquin, School of Medicine) ;
  • Somashekar G. Krishna (Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center) ;
  • Emmanuel Coronel (Division of Gastroenterology and Hepatology, MD Anderson Cancer Center) ;
  • Paul T. Kroner (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Herbert C. Wolfsen (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Michael B. Wallace (Division of Gastroenterology and Hepatology, Mayo Clinic) ;
  • Juan E. Corral (Division of Gastroenterology and Hepatology, Presbyterian Health Services)
  • Received : 2021.02.22
  • Accepted : 2021.05.10
  • Published : 2022.03.30
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Abstract

Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needle-based CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.

Keywords

References

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