Gastrointestinal Endoscopy
Volume 74, Issue 5 , Pages 1049-1060, November 2011

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

  • Vani J.A. Konda, MD

      Affiliations

    • Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
    • ,
  • Harry R. Aslanian, MD

      Affiliations

    • Section of Gastroenterology, Department of Medicine, Yale University, New Haven, Connecticut, USA
    • ,
  • Michael B. Wallace, MD, MPH

      Affiliations

    • Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA
    • ,
  • Uzma D. Siddiqui, MD

      Affiliations

    • Section of Gastroenterology, Department of Medicine, Yale University, New Haven, Connecticut, USA
    • ,
  • John Hart, MD

      Affiliations

    • Department of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA
    • ,
  • Irving Waxman, MD

      Affiliations

    • Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
    • Corresponding Author InformationReprint requests: Irving Waxman, MD, The Center for Endoscopic Research and Therapeutics, University of Chicago Medical Center, 5758 South Maryland Avenue, MC 9028, Chicago, IL 60637

Received 25 February 2011; accepted 1 July 2011. published online 19 September 2011.

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.

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

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 DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Drs. Konda, Wallace, Waxman, and Hart acknowledge financial relationships with Mauna Kea Technologies, the device manufacturer, in the forms of consultation, research support, and/or honoraria. The other authors disclosed no financial relationships relevant to this publication. Support from Mauna Kea Technologies for this study was in the form of temporary use of the prototype devices and assistance with data collection and transfer.

PII: S0016-5107(11)01958-4

doi:10.1016/j.gie.2011.07.018

Gastrointestinal Endoscopy
Volume 74, Issue 5 , Pages 1049-1060, November 2011

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