Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
- Author:
Do Han KIM
1
;
Somashekar G. KRISHNA
;
Emmanuel CORONEL
;
Paul T. KRÖNER
;
Herbert C. WOLFSEN
;
Michael B. WALLACE
;
Juan E. CORRAL
Author Information
- Publication Type:Systematic Review and Meta-Analysis
- From:Clinical Endoscopy 2022;55(2):197-207
- CountryRepublic of Korea
- Language:English
-
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.
