Appraisal of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic cysts |
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Authors: | Somashekar G Krishna;Jeffery H Lee; |
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Institution: | Somashekar G Krishna, Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, OH 43210, United StatesJeffery H Lee, Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States |
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Abstract: | Nearly 2.5% of cross-sectional imaging studies will report a finding of a cystic pancreatic lesion. Eventhough most of these are incidental findings, it remains very concerning for both patients and treating clinicians. Differentiating and predicting malignant transformation in pancreatic cystic lesions is clinically challenging. Current evaluation of suspicious cystic lesions includes a combination of radiologic imaging, endoscopic ultrasound(EUS) and cyst fluid analyses. Despite these attempts, precise diagnostic stratification among nonmucinous, mucinous, and malignant cystic lesions is often not possible until surgical resection. EUS-guided needle based confocal laser endomicroscopy(n CLE) for evaluation of pancreatic cysts is emerging as a powerful technique with remarkable potential. Though limited imaging data from 3 large clinical trials(INSPECT, DETECT and CONTACT) are currently the reference standard for n CLE imaging, nonetheless these have not been validated in large studies. The aim of this review article is to review the evolving role of EUS-guided n CLE in management of pancreatic cystic lesions in terms of its significance, adverse events, limitations, and implications. |
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Keywords: | Pancreatic cyst Needle-based confocal laser endomicroscopy Endoscopic ultrasound Intraductal papillary mucinous neoplasm Mucinous cystadenoma Serous cystadenoma Pancreatic cancer |
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