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Gastrointest Endosc. 2015 May;81(5):1204-14. doi: 10.1016/j.gie.2014.10.025. Epub 2015 Jan 26.

Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study.

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1
H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Orange, California, USA.

Abstract

BACKGROUND:

The diagnosis of pancreatic cystic neoplasms (PCNs), which now depends on morphology, cytology, and fluid analysis, is still challenging. A novel confocal laser endomicroscopy probe that can be inserted through a 19-gauge FNA needle allows needle-based confocal laser endomicroscopy (nCLE), and the feasibility of nCLE has been reported in PCNs. The combination of cystoscopy by using a through-the-needle fiberoptic probe in combination with nCLE under EUS guidance may improve the diagnosis of PCNs.

OBJECTIVE:

To assess the feasibility, safety, and diagnostic yield of the combination of cystoscopy and nCLE in the clinical diagnosis of PCNs.

DESIGN:

A prospective feasibility study.

SETTING:

An academic tertiary referral center.

PATIENTS:

Thirty patients with PCNs.

INTERVENTIONS:

EUS-guided dual through-the-needle imaging (cystoscopy and nCLE) for PCNs.

MAIN OUTCOME MEASUREMENTS:

Technical feasibility and safety. Associations of cystoscopy and nCLE findings with clinical diagnosis of PCNs.

RESULTS:

The procedure was technically successful with the exception of 1 probe exchange failure. In 2 patients (7%), postprocedure pancreatitis developed. Specific features associated with the clinical diagnosis of mucinous cysts were identified: mucin on cystoscopy and papillary projections and dark rings on nCLE. The sensitivity of cystoscopy was 90% (9/10), and that of nCLE was 80% (8/10), and the combination was 100% (10/10) in 18 high-certainty patients.

LIMITATIONS:

A single-center study and lack of complete pathologic correlation.

CONCLUSION:

The combination of dual through-the-needle imaging (cystoscopy and nCLE) of pancreatic cysts appears to have strong concordance with the clinical diagnosis of PCN. (

CLINICAL TRIAL REGISTRATION NUMBER:

NCT01447238.).

PMID:
25634486
DOI:
10.1016/j.gie.2014.10.025
[Indexed for MEDLINE]
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