Patients with chronic pancreatitis may develop complications such as chronic debilitating abdominal pain related to neuropathy, pancreatic duct leaks, pseudocysts, pancreatic carcinoma, pancreatic duct calcifications and strictures. Management of mechanical complications of chronic pancreatitis may pose a significant challenge to the interventional endoscopist. The purpose of this manuscript is to explore the latest developments in interventional techniques and to set the stage for future investigations.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Endoscopy, Gastrointestinal ; Endosonography ; Humans ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Pancreatitis, Chronic*

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.