Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management

Confocal Laser Endomicroscopy in Gastrointestinal and Pancreatobiliary Diseases: A Systematic Review and Meta-Analysis

“…Currently, in humans, the use of nCLE is exclusively applied to pancreatic tissue. The literature concerning this technique includes a small number of studies that examined the characterization of pancreatic lesions, such as pancreatic cystic neoplasms [ 14 , 15 , 117 ], indeterminate pancreatic duct strictures [ 116 ], and serous cystadenomas [ 118 ] ( Table 5 ). A meta-analysis of two studies [ 14 , 117 ] that applied nCLE for the diagnosis of pancreatic cyst neoplasms produced a pooled sensitivity of 68% (CI 95% : 55%–80%; I 2 : 79.8%), a pooled specificity of 90% (CI 95% : 74%–98%; I 2 : 82.4%), a pooled positive LR of 6.72 (CI 95% : 0.94–47.89; I 2 : 52%), and a pooled negative LR of 0.30 (CI 95% : 0.10–0.84; I 2 : 60.6%) (Figure S3).…”

Diagnostic Value of Endomicroscopy for Gastrointestinal Diseases: New Possibilities and Concepts

“…The first described of probe-based confocal laser endomicroscopy in the pancreatic duct was publishes in 2015 (40). Eighteen patients were investigated.…”

Novel diagnostic and therapeutic modalities using endoscopic ultrasound in pancreatic disease

“…33,40 Sensitivity of histopathology alone was 50%, relative to 83% when using pCLE. 33,40 Kahaleh et al 39 also showed pCLE diagnoses aligned with that based on cytology or histopathology with a Kappa coefficient of 0.8 (P ≤ 0.0001) in their evaluation in 18 patients. An extensive literature review by Almadi and Neumann 41 found CLE in combination with endoscopic retrograde cholangiopancreatography (ERCP) for the assessment of indeterminate ductal strictures increased the sensitivity to 98% relative to 45% with ERCP alone, but resulted in a lower specificity (67% vs 100%).…”

“…Despite use of brush cytology to aid in endoscopic diagnosis, sensitivity remains less than ideal, often not exceeding 70%. 33,39 Meining et al 40 reported one of the first studies evaluating pCLE in the evaluation of pancreatobiliary duct strictures of indeterminate etiology. 33,41 In their study of 14 patients, pCLE exhibited an overall accuracy of 86% (compared to histopathology's diagnostic accuracy of 79%), based on patterns such as: large clumps of decreased fluorescent dye uptake, saccular vessels, and the loss of a reticular pattern of epithelium.…”