A prospective trial of CONfocal endomicroscopy in CYSTic lesions of the pancreas: CONCYST-01

Margaret G. Keane; Natascha Wehnert; Miguel Perez-Machado; Giuseppe K. Fusai; Douglas Thorburn; Kofi W. Oppong; Nicholas Carroll; Andrew J. Metz; Stephen P. Pereira

doi:10.1055/a-0957-2976

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(09): E1117-E1122
DOI: 10.1055/a-0957-2976

Original article

A prospective trial of CONfocal endomicroscopy in CYSTic lesions of the pancreas: CONCYST-01

Margaret G. Keane

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

,

Natascha Wehnert

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

,

Miguel Perez-Machado

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

,

Giuseppe K. Fusai

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

,

Douglas Thorburn

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

,

Kofi W. Oppong

²Department of Gastroenterology and HPB Unit, Freeman Hospital, Newcastle upon Tyne, UK & Institute of Cellular Medicine Newcastle University, Newcastle upon Tyne, UK

,

Nicholas Carroll

³Cambridge University Hospital NHS Foundation Trust, Cambridge, UK

,

Andrew J. Metz

⁴Department of Gastroenterology, Royal Melbourne Hospital, Parkville VIC, Australia

,

Stephen P. Pereira

¹Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, UK

› Author Affiliations

Abstract

Background and study aims Pancreatic cystic lesions (PCL) are common. While some harbor malignant potential, accurate preoperative diagnosis remains challenging. Needle-based confocal laser endomicroscopy (nCLE) via a 19G FNA needle enables real-time imaging of the cyst wall. This study evaluated the safety and utility of nCLE in patients with an indeterminate PCL undergoing EUS-FNA.

Patients and methods The CONCYST study prospectively recruited patients with indeterminate PCL attending three hepatopancreaticobiliary (HPB) referral centers in the UK, with indeterminate PCL, who required EUS-FNA between July 2014 and October 2016. Following the procedure, all patients were followed up in telephone clinic for at least 12 months. Ethical approval for the study was granted by the National Research Ethics Service (14/LO/0040).

Results Sixty-seven patient were recruited, 11 excluded and 56 included in the final analysis: 35 male, 21 female; median age 68 (range 28 – 80). Recognizable confocal images were obtained in 48 of 56 cases. Median nCLE scanning time was 5 minutes and did not exceed 10 minutes in any case. EUS-nCLE findings correlated with final diagnosis (based on imaging, cytology and multidisciplinary team review) in 43/56 (77 %) of cases, compared with 37/56 (66 %) for cytology alone (P = 0.12). One patient experienced mild pruritus following the procedure and another developed an infected pseudocyst, which resolved with antibiotics.

Conclusions EUS-nCLE under conscious sedation in the day case setting is safe and provides additional information to standard EUS-FNA for diagnosing indeterminate PCL.

Full Text

References

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