Gastrointestinal endoscopy | 2019
Impact of EUS-guided microforceps biopsy and needle-based confocal laser endomicroscopy on the diagnostic yield and clinical management of pancreatic cystic lesions.
Abstract
BACKGROUND AND AIMS\nEUS-guided microforceps biopsy (MFB) and needle-based confocal laser endomicroscopy (nCLE) are emerging diagnostic tools for pancreatic cystic lesions (PCLs). There is a paucity of data regarding their performance and impact. The aim of this study was to compare diagnostic outcomes and changes in clinical management resulting from MFB and nCLE use in PCLs.\n\n\nMETHODS\nSingle-center retrospective study of patients with PCLs who underwent combined EUS-guided FNA, MFB, and nCLE. Primary outcomes included diagnostic yield (specific PCL type) and change in clinical management for each modality compared with the current composite standard (CS) obtained by combining clinical, morphologic, cyst fluid cytology, and chemical analysis.\n\n\nRESULTS\nA total of 44 cysts were studied in 44 patients. Technical success: EUS-FNA 100%, MFB 88.6%, nCLE 97.7%. Adverse events: 1 out of 44 (2.3%, one infected pseudocyst). Diagnostic yield for each individual modality: CS 34.1%, MFB 75.0% (p<0.05 vs CS), nCLE, 84.1% (p<0.05 vs CS). Diagnostic yield for combined tests: CS/MFB 79.5%, CS/nCLE, 88.6%, CS/MFB/nCLE, 93.2% (p=NS). Compared with the CS, the use of MFB, nCLE, and their combination, led to overall change in clinical management in 38.6%, 43.2%, and 52.3% of cases. MFB and nCLE led to an overall increase in discontinuation of surveillance (MFB 34.1% p<0.05, nCLE 31.8%, p<0.05), led by a reduction in the indication for follow-up radiologic or endoscopic studies (MFB 34.1%, p<0.05, nCLE 38.6%, p<0.05). Based on MFB and nCLE, 2 out of 28 (7.1%) and 3 out of 28 (10.7%) patients who would have undergone further surveillance were referred for surgery.\n\n\nCONCLUSION\nIn the evaluation of PCLs, the use of combined EUS-guided FNA, MFB and nCLE is safe. MFB and nCLE lead to significant improvements in specific PCL diagnosis, which in turn has major impact in clinical management.