Outcome of probe‐based confocal laser endomicroscopy (pCLE) during endoscopic retrograde cholangiopancreatography: A single‐center prospective study in 45 patients

Abstract

Background: Diagnosis of pre-malignant and malignant lesions in the bile duct and the pancreas is sometimes cumbersome. This applies in particular to intraductal papillary mucinous neoplasia (IPMN) and bile duct strictures in primary sclerosing cholangitis (PSC). Aims: To evaluate in a prospective cohort study the sensitivity and specificity of probe-based confocal laser microscopy (pCLE) during endoscopic retrograde cholangiopancreatography (ERCP). Methods: We performed pCLE together with mother-baby endoscopy (SpyGlass) during 50 ERCP sessions in 45 patients. The Miami and Paris criteria were applied. Clinical diagnosis via imaging was compared to pCLE and the final pathological diagnosis from surgically-resected, biopsy, or cytology specimens. Patients were followed up for at least 1 year. Results: We were able to perform pCLE in all patients. Prior to endoscopy, the diagnosis was benign in 23 patients and undetermined (suspicious) in 16 patients, while six patients had an unequivocal diagnosis of malignancy. Sensitivity was 91% and specificity 52%. The positive (PPV) and negative predictive value (NPV) was 82% and 100%, respectively. Apart from mild post-ERCP pancreatitis in two patients, no complications occurred. Conclusions: Our study showed that pCLE is a safe, expert endoscopic method with high technical feasibility, high sensitivity and high NPV. It provided diagnostic information that can be helpful for decisions on patient management, especially in the case of IPMN and unclear pancreatic lesions, in individuals whom are at increased risk for pancreatic cancer.

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

“…1 The recent updated guidelines 2 emphasized that images, and even video sequences, captured during endoscopic examinations and therapeutic interventions are considered almost mandatory to achieve a high level of quality documentation. With the increased use of advanced imaging technologies such as high definition white-light endoscopy, conventional or virtual chromoendoscopy, probe-based confocal laser endomicroscopy, 3 the demands for image storage, interpretation and standardization have expanded even further, 4,5 Studies on the agreement between investigators in the assessment of endoscopic images are of vital importance not only for clinical practice but even more so in the design of and reporting on research protocols.…”

Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

“…Although bleeding in the target lesion usually disrupts the precise evaluation with NBI, pCLE can be performed regardless of bleeding. Correspondingly, the development of pCLE enables us to perform an optical biopsy of several other organs, including the esophagus [ 28 ], lung [ 29 ], biliary tract [ 30 ], pancreas [ 31 ], and urinary tract [ 32 ]. The optimal dose of fluorescein for lesions with inflammation and in other organs may differ and these should be investigated individually.…”

Manejo y diagnóstico del colangiocarcinoma formador de masa a propósito de un caso

“…Las posibilidades de pancreatitis después del procedimiento son bastante infrecuentes, aunque ha sido descrita en casos sin esfinterotomía previa. 17,18 La microendoscopía confocal (EMF) permite el examen histológico in vivo y en tiempo real de las superficies mucosas, obteniendo imágenes de alta resolución del epitelio pancreatobiliar, aumentando el rendimiento diagnóstico histopatológico estándar con una concordancia del 85% comparado a la histología estándar. En las estenosis biliares indeterminadas o en lesiones pancreáticas, la EMF tiene una sensibilidad del 98% y especificidad del 67 al 73%.…”