Clin Endosc.  2022 Mar;55(2):197-207. 10.5946/ce.2021.079.

Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis

• Kim DH
• Krishna SG
• Coronel E
• Kröner PT
• Wolfsen HC
• Wallace MB
• Corral JE

• KMID: 2527561
• DOI: http://doi.org/10.5946/ce.2021.079

Abstract

Background/Aims
Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for its 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%). Needlebased 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.

Keyword

Biliary stricture; Cholangiocarcinoma; Confocal microscopy; Endoscopy; Pancreatic cyst

Figure

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  Fig. 1. Comparison of available endomicroscopy imaging technologies. FICE, Fujinon Intelligent Chromo Endoscopy (Fujinon, Saitama, Japan); HD, hight definition; iScan (Pentax Inc., Tokyo, Japan)); NBI, narrow band Imaging (Olympus Medical Systems Corp., Tokyo, Japan); OCT, optical coherence tomograpy; VLE, volumetric laser endomicroscopy. Courtesy of Dr. Wallace MB.

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  Fig. 2. Literature review flowchart. MeSH, medical subject headings used by the National Library of Medicine.

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  Fig. 3. Representative patterns of probe-based confocal laser endomicroscopy in biliary ducts conditions. Courtesy of Mauna Kea Technologies, Inc.

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  Fig. 4. Representative patterns of needle-based confocal laser endomicroscopy in pancreatic cysts. Pseudocyst can have a dark or light background. Cystic NET and SPT can only be differentiated using immunostaining. IPMN, intraductal mucinous papillary neoplasm; MCN, mucinous cystic neoplasm; NET, neuroendocrine tumor; SCA, serous cystadenoma; SPT, solid pseudopapillary tumor. Courtesy of Krishna SG.

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