scholarly journals Needle-Based Confocal Laser Endomicroscopy: A New Promising Armamentarium for Diagnostic Endoscopic Ultrasound

2019 ◽  
Vol 10 (02) ◽  
pp. 137-140
Author(s):  
Jimil Shah ◽  
Surinder S Rana
Keyword(s):  
Endoscopic Ultrasound ◽  
Pancreatic Cyst ◽  
Colonic Polyps ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Criteria For Diagnosis ◽  
Subepithelial Lesions ◽  
Epithelial Lesions

AbstractWith increasing use of cross-sectional imaging in diagnosis of various diseases, incidence of asymptomatic pancreatic cyst has increased dramatically in last decade. In management of such asymptomatic pancreatic cyst differentiation of pre-malignant cyst and benign cyst remains an utmost important parameter. Though various endoscopic ultrasound (EUS) criteria have been developed, differentiation between these two entities still remains a challenge in many patients. Confocal laser endomicroscopy (CLE) has shown promising results in diagnosis of various gastrointestinal cancers and colonic polyps. However, CLE criteria have not been prospectively validated in asymptomatic pancreatic cyst to differentiate premalignant vs benign cysts. Similarly, CLE criteria are also not defined for diagnosis of various gastric sub-epithelial lesions. In this news and views we have discussed two important articles regarding role of needle based CLE (nCLE) in these lesions. While one is a multicentric trial which prospectively validates previously defined nCLE criteria for characterizing pancreatic cystic lesion, second developed criteria for diagnosis of various gastric subepithelial lesions based on nCLE findings.

Endoscopic ultrasound‐guided needle‐based confocal laser endomicroscopy in gastrointestinal subepithelial lesions: Feasibility study

2019 ◽  
Vol 32 (4) ◽  
pp. 574-584 ◽  
Author(s):  
Tsuyoshi Terada ◽  
Tomomitsu Tahara ◽  
Senju Hashimoto ◽  
Noriyuki Horiguchi ◽  
Kohei Funasaka ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Endoscopic Ultrasound ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Ultrasound Guided ◽  
Subepithelial Lesions

scholarly journals Sa2008 ENDOSCOPIC ULTRASOUND-GUIDED NEEDLE-BASED CONFOCAL LASER ENDOMICROSCOPY IN GASTROINTESTINAL SUBEPITHELIAL LESIONS - A FEASIBILITY STUDY

2020 ◽  
Vol 91 (6) ◽  
pp. AB239
Author(s):  
Naoki Ohmiya ◽  
Tsuyoshi Terada ◽  
Tomomitsu Tahara ◽  
Senju Hashimoto ◽  
Noriyuki Horiguchi ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Endoscopic Ultrasound ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Ultrasound Guided ◽  
Subepithelial Lesions

scholarly journals Pancreatic Cysts: Diagnostic Role of EUS-Guided Microforceps Biopsy and Confocal Laser Endomicroscopy

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Darina Kohoutova ◽  
Sameer Zar ◽  
Rudolf Repak ◽  
Panagiotis Vlavianos ◽  
Jan Bures
Keyword(s):  
Clinical Decision Making ◽  
Diagnostic Yield ◽  
Cyst Fluid ◽  
Confocal Laser Endomicroscopy ◽  
Diagnostic Tools ◽  
Confocal Laser ◽  
Pancreatic Cysts ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

Frequent use of high-quality cross-sectional imaging has led to a significant rise in diagnosis of pancreatic cystic lesions (PCLs). Despite the fact that enormous effort has been put into the research of PCLs within the last two decades and multiple guidelines have been developed, our clinical decision-making especially in regard to mucinous lesions remains limited. Currently, clinical assessment, cross-sectional imaging and EUS with fluid analysis (if appropriate) belong to the standard care in patients with PCLs. For differentiation of mucinous from nonmucinous cysts, the sensitivity of cytological investigation and CEA in the cyst fluid is 42% and 52-79%, respectively. Due to the limited accuracy, further diagnostic tools are warranted. Two EUS-guided approaches have been introduced recently. Through-the-(19-gauge EUS) needle Moray microforceps have been developed, and several studies have acknowledged their contribution to the correct diagnosis as they help to overcome limited cellularity of the EUS-guided cyst fluid aspiration and traditional cytology. Confocal laser endomicroscopy offers real-time images and seems to be a promising method for the diagnosis and differential diagnosis of pancreatic PCLs. Example images of the needle-based confocal laser endomicroscopy criteria for the diagnosis of PCLs have been suggested recently. Before both, Moray microforceps and confocal laser endomicroscopy can be widely accepted, further studies are necessary to determine the real diagnostic yield and the clinical efficacy.

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study

Endoscopy ◽  
2018 ◽  
Vol 51 (06) ◽  
pp. 560-565 ◽  
Author(s):  
Ming-Ming Zhang ◽  
Ning Zhong ◽  
Xiao Wang ◽  
Chang-Qing Li ◽  
Rui Ji ◽  
...  
Keyword(s):  
Image Quality ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Ultrasound Guided ◽  
Diagnostic Efficacy ◽  
Gastric Subepithelial Tumors ◽  
The Mean ◽  
Subepithelial Tumors

Abstract Background The diagnostic yield of current techniques for gastric subepithelial tumors (SETs) is suboptimal. This prospective study aimed to develop diagnostic criteria for needle-based confocal laser endomicroscopy (nCLE) of gastric SETs, and to evaluate the diagnostic efficacy, feasibility, and safety of endoscopic ultrasound-guided nCLE (EUS-nCLE). Methods Eligible patients were prospectively recruited to undergo EUS-nCLE. Four unblinded investigators evaluated nCLE videos and corresponding histopathology to develop the nCLE criteria. The recorded nCLE videos were reviewed off-line by one endoscopist 3 months later. Image quality (five-point scale, 1 = poor and 5 = very good) and the interobserver agreements were assessed. Results All 33 patients underwent successful EUS-nCLE procedures. The nCLE criteria for gastric SETs were established. Overall accuracy of off-line nCLE was significantly higher than that of EUS alone (87.9 % vs. 63.6 %; P = 0.02). The mean image quality score was 3.9. The kappa values of the interobserver agreements were 0.66 for gastrointestinal stromal tumor, 0.89 for ectopic pancreas, 0.58 for leiomyoma, and 0.72 for carcinoma. Conclusions EUS-nCLE was feasible and safe to accurately diagnose gastric SETs.

scholarly journals Endoscopic ultrasound guided needle-based confocal laser endomicroscopy in solid pancreatic masses – a prospective validation study

2018 ◽  
Vol 06 (01) ◽  
pp. E78-E85 ◽  
Author(s):  
John Karstensen ◽  
Tatiana Cârţână ◽  
Codruţa Constantinescu ◽  
Silviu Dumitrașcu ◽  
Bojan Kovacevic ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
Needle Aspiration ◽  
Observer Agreement ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Dark Cell ◽  
Pancreatic Masses ◽  
Pass Through

Abstract Background and study aims Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is a keystone in diagnosing and staging of pancreatic masses. Recently, a microfiber that can pass through a 19-gauge needle has been introduced for confocal laser endomicroscopy (nCLE). The aims of this study were to evaluate the diagnostic value and the reproducibility of nCLE criteria for solid malignant lesions. Patients and methods This prospective dual-center study included patients with pancreatic masses suspicious of malignancy referred for EUS-FNA. Endomicroscopic imaging was performed under EUS-guidance until organ-specific structures were obtained. Afterwards, standard cytology was obtained and patients were followed for up to 12 months. All nCLE parameters included in former studies were correlated with the final diagnosis (dark lobular structures/normal acinar cells, dark cell aggregates > 40 µm, dilated irregular vessels with fluorescein leakage, fine white fibrous bands, small black cell movements, pseudoglandular structures). Finally, three CLE novices and three CLE experts assessed the unedited movies from all patients. Results Twenty-eight patients were enrolled in the study. A final diagnosis was obtained in 24 patients (86 %). One patient (3 %) died before a diagnosis was obtained, while 3 were lost to follow-up (11 %). In 18/24 patients (74 %) the diagnosis was malignant. The mean sensitivity, specificity, and accuracy for the nCLE parameters ranged from 19 – 93 %, 0 – 56 %, 26 – 69 %, respectively. The inter-observer values ranged from κ = 0.20 – 0.41 for novices and κ = –0.02 – 0.38 for experts. Conclusions The diagnostic value of nCLE in solid pancreatic masses is questionable and the inter-observer agreement for both novices and CLE experts appears limited.

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