Clinical Endoscopy

  • 제57권4호
  • /
  • Pages.434-445
  • /
  • 2024
  • /
  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
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Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects

  • 투고 : 2023.06.22
  • 심사 : 2024.03.05
  • 발행 : 2024.07.30
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초록

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

키워드

과제정보

The authors thank Medtronic for providing the GI Genius endoscopy module. Additionally, we extend our heartfelt thanks to the doctors and endoscopy nurses in the Department of Gastrointestinal Surgery at the University Hospital of Southern Denmark whose support and cooperation greatly facilitated the successful completion of this research project.

참고문헌

  1. Park J, Park J, Lee YS, et al. Increased incidence of indeterminate pancreatic cysts and changes of management pattern: evidence from nationwide data. Hepatobiliary Pancreat Dis Int 2023;22:294-301.
  2. Moris M, Bridges MD, Pooley RA, et al. Association between advances in high-resolution cross-section imaging technologies and increase in prevalence of pancreatic cysts from 2005 to 2014. Clin Gastroenterol Hepatol 2016;14:585-593.
  3. Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver 2015;9:571-589.
  4. Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802-807.
  5. Ishikawa T, Takeda K, Itoh M, et al. Prevalence of pancreatic cystic lesions including intraductal papillary mucinous neoplasms in patients with end-stage renal disease on hemodialysis. Pancreas 2009;38:175-179.
  6. Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 2008;247:571-579.
  7. Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 2004;239:678-687.
  8. Chari ST, Kelly K, Hollingsworth MA, et al. Early detection of sporadic pancreatic cancer: summative review. Pancreas 2015;44:693-712.
  9. Rahib L, Smith BD, Aizenberg R, et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 2014;74:2913-2921.
  10. Scheiman JM, Hwang JH, Moayyedi P. American Gastroenterological Association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:824-848.
  11. Elta GH, Enestvedt BK, Sauer BG, et al. ACG clinical guideline: diagnosis and management of pancreatic cysts. Am J Gastroenterol 2018;113:464-479.
  12. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004;126:1330-1336.
  13. Brandwein SL, Farrell JJ, Centeno BA, et al. Detection and tumor staging of malignancy in cystic, intraductal, and solid tumors of the pancreas by EUS. Gastrointest Endosc 2001;53:722-727.
  14. Mauna Kea Technologies. List of EUS-FNA needles successfully used with AQ-Flex 19 confocal miniprobes. Mauna Kea Technologies; 2020.
  15. Konda VJ, Aslanian HR, Wallace MB, et al. First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos). Gastrointest Endosc 2011;74:1049-1060.
  16. Konda VJ, Meining A, Jamil LH, et al. A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy 2013;45:1006-1013.
  17. Nakai Y, Iwashita T, Park DH, et al. Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204-1214.
  18. Napoleon B, Lemaistre AI, Pujol B, et al. In vivo characterization of pancreatic cystic lesions by needle-based confocal laser endomicroscopy (nCLE): proposition of a comprehensive nCLE classification confirmed by an external retrospective evaluation. Surg Endosc 2016;30:2603-2612.
  19. Chin YK, Khor CJ, Goh BK, et al. The clinical evaluation of needle-based confocal laser endomicroscopy in the assessment of pancreatic cystic lesion: a pilot study. Proc Singap Healthc 2018;27:96-102.
  20. Napoleon B, Palazzo M, Lemaistre AI, et al. Needle-based confocal laser endomicroscopy of pancreatic cystic lesions: a prospective multicenter validation study in patients with definite diagnosis. Endoscopy 2019;51:825-835.
  21. Keane MG, Wehnert N, Perez-Machado M, et al. A prospective trial of CONfocal endomicroscopy in CYSTic lesions of the pancreas: CONCYST-01. Endosc Int Open 2019;7:E1117-E1122.
  22. Kadayifci A, Atar M, Basar O, et al. Needle-based confocal laser endomicroscopy for evaluation of cystic neoplasms of the pancreas. Dig Dis Sci 2017;62:1346-1353.
  23. Karia K, Waxman I, Konda VJ, et al. Needle-based confocal endomicroscopy for pancreatic cysts: the current agreement in interpretation. Gastrointest Endosc 2016;83:924-927.
  24. Krishna SG, Swanson B, Hart PA, et al. Validation of diagnostic characteristics of needle based confocal laser endomicroscopy in differentiation of pancreatic cystic lesions. Endosc Int Open 2016;4:E1124-E1135.
  25. Krishna SG, Brugge WR, Dewitt JM, et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc 2017;86:644-654.
  26. Palazzo M, Sauvanet A, Gincul R, et al. Impact of needle-based confocal laser endomicroscopy on the therapeutic management of single pancreatic cystic lesions. Surg Endosc 2020;34:2532-2540.
  27. Cheesman AR, Zhu H, Liao X, et al. Impact of EUS-guided micro-forceps biopsy sampling and needle-based confocal laser endomicroscopy on the diagnostic yield and clinical management of pancreatic cystic lesions. Gastrointest Endosc 2020;91:1095-1104.
  28. Napoleon B, Lemaistre AI, Pujol B, et al. A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 2015;47:26-32.
  29. Krishna SG, Hart PA, DeWitt JM, et al. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video). Gastrointest Endosc 2020;91:551-563.
  30. Krishna SG, Swanson B, Conwell DL, et al. In vivo and ex vivo needle-based confocal endomicroscopy of intraductal papillary mucinous neoplasm of the pancreas. Gastrointest Endosc 2015;82:571-572.
  31. Machicado JD, Napoleon B, Lennon AM, et al. Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions. Pancreatology 2022;22:994-1002.
  32. Le Pen C, Palazzo L, Napoleon B. A health economic evaluation of needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cysts. Endosc Int Open 2017;5:E987-E995.
  33. Machicado JD, Chao WL, Carlyn DE, et al. High performance in risk stratification of intraductal papillary mucinous neoplasms by confocal laser endomicroscopy image analysis with convolutional neural networks (with video). Gastrointest Endosc 2021;94:78-87.
  34. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018;67:789-804.
  35. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738-753.
  36. Helms MM, Nixon J. Exploring SWOT analysis: where are we now?: a review of academic research from the last decade. J Strategy Manag 2010;3:215-251.
  37. Keane MG, Afghani E. A review of the diagnosis and management of premalignant pancreatic cystic lesions. J Clin Med 2021;10:1284.
  38. Durkin C, Krishna SG. Advanced diagnostics for pancreatic cysts: confocal endomicroscopy and molecular analysis. World J Gastroenterol 2019;25:2734-2742.
  39. McCarty TR, Garg R, Rustagi T. Pancreatic cyst fluid glucose in differentiating mucinous from nonmucinous pancreatic cysts: a systematic review and meta-analysis. Gastrointest Endosc 2021;94:698-712.