First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos)

Vani J.A. Konda, Harry R. Aslanian, Michael B. Wallace, Uzma D. Siddiqui, John Hart, Irving Waxman

Research output: Contribution to journalArticle

105 Scopus citations

Abstract

Background: Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle. Objective: To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions. Design: Feasibility study. Setting: Multicenter, tertiary care. Patients: Eighteen patients presenting for EUS-FNA. Interventions: Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle. Main Outcome Measurements: Device integrity, technical ease, safety, and image acquisition. Results: Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization. Limitations: Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images. Conclusions: nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.

Original languageEnglish (US)
Pages (from-to)1049-1060
Number of pages12
JournalGastrointestinal endoscopy
Volume74
Issue number5
DOIs
StatePublished - Nov 1 2011

Keywords

  • CEA
  • CLE
  • EUS-FNA
  • EUS-guided FNA
  • IPMN
  • carcinoembryonic antigen
  • confocal laser endomicroscopy
  • intraductal papillary mucinous neoplasm
  • nCLE
  • needle-based confocal laser endomicroscopy
  • pCLE
  • probe-based confocal laser endomicroscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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