Clin Endosc.  2016 Sep;49(5):462-466. 10.5946/ce.2016.086.

A Review of Probe-Based Confocal Laser Endomicroscopy for Pancreaticobiliary Disease

• Karia K
• Kahaleh M

• KMID: 2356054
• DOI: http://doi.org/10.5946/ce.2016.086

Abstract

Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.

Keyword

Confocal endomicroscopy; Pancreatic cyst; Indeterminate biliary stricture; Cholangiopancreatography, endoscopic retrograde

MeSH Terms

Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Constriction, Pathologic
Pancreatic Cyst
Pathology
Ultrasonography

Figure

• 

  Fig. 1. Probed-based confocal laser endomicroscopy findings in the healthy bile duct. (A) Reticular network of thin dark branching bands (<20 µm) with light gray background. (B) Vessels <20 µm.

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  Fig. 2. The Miami classification for malignant pancreaticobiliary strictures. (A) Epithelial structures. (B) Thick dark bands (>40 µm). (C) Thick white bands (>20 µm). (D) Dark clumps.

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  Fig. 3. The Paris classification for inflammatory strictures. (A) Vascular congestion. (B) Dark granular pattern with scales. (C) Increased interglandular space. (D) Thickened reticular structures.

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  Fig. 4. Needle-based confocal laser endomicroscopy findings with 100% specificity. (A) Villous structures in mucinous pancreatic cystic lesions. (B) Superficial vascular network in serous cystadenomas.

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