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Gastrointest Endosc. 2011 Nov;74(5):1049-60. doi: 10.1016/j.gie.2011.07.018. Epub 2011 Sep 15.

First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos).

Author information

1
Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA.

Abstract

BACKGROUND:

Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle.

OBJECTIVE:

To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions.

DESIGN:

Feasibility study.

SETTING:

Multicenter, tertiary care.

PATIENTS:

Eighteen patients presenting for EUS-FNA.

INTERVENTIONS:

Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle.

MAIN OUTCOME MEASUREMENTS:

Device integrity, technical ease, safety, and image acquisition.

RESULTS:

Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization.

LIMITATIONS:

Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images.

CONCLUSIONS:

nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.

PMID:
21924718
DOI:
10.1016/j.gie.2011.07.018
[Indexed for MEDLINE]

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