Confocal endomicroscopy for evaluation of pancreatic cystic lesions: a systematic review and international Delphi consensus report

Bertrand Napoleon; Somashekar G. Krishna; Bruno Marco; David Carr-Locke; Kenneth J. Chang; Àngels Ginès; Frank G. Gress; Alberto Larghi; Kofi W. Oppong; Laurent Palazzo; Pradermchai Kongkam; Carlos Robles-Medranda; Divyesh Sejpal; Damien Tan; William R. Brugge

doi:10.1055/a-1229-4156

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1566-E1581
DOI: 10.1055/a-1229-4156

Original article

Confocal endomicroscopy for evaluation of pancreatic cystic lesions: a systematic review and international Delphi consensus report

Bertrand Napoleon

¹Département de Gastroentérologie, Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France

,

Somashekar G. Krishna

²Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States

,

Bruno Marco

³Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands

,

David Carr-Locke

⁴The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States

,

Kenneth J. Chang

⁵Gastroenterology and Hepatology Division, H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, California, United States

,

Àngels Ginès

⁶Endoscopy Unit. Department of Gastroenterology. Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona. Catalunya, Spain

,

Frank G. Gress

⁷Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, United States

,

Alberto Larghi

⁸Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy

,

Kofi W. Oppong

⁹Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom

,

Laurent Palazzo

¹⁰Clinique du Trocadéro, Paris, France

,

Pradermchai Kongkam

¹¹Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.

,

Carlos Robles-Medranda

¹²Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador

,

Divyesh Sejpal

¹³Division of Gastroenterology, Department of Medicine, Hofstra Northwell School of Medicine, Northwell Health System, North Shore University Hospital, Manhasset, New York, United States

,

Damien Tan

¹⁴Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore

,

William R. Brugge

¹⁵Division of Gastroenterology Mount Auburn Hospital Cambridge, Massachusetts, United States

› Institutsangaben

Abstract

Background and study aims The aim of thi systematic review and consensus report is to standardize the practice of endoscopic ultrasound (EUS-guided needle-based confocal laser endomicroscopy (nCLE) for pancreatic cystic lesion (PCL) evaluation.

Methods We performed an international, systematic, evidence-based review of the applications, outcomes, procedural processes, indications, training, and credentialing of EUS-nCLE in management of PCLs. Based on available clinical evidence, preliminary nCLE consensus statements (nCLE-CS) were developed by an international panel of 15 experts in pancreatic diseases. These statements were then voted and edited by using a modified Delphi approach. An a priori threshold of 80 % agreement was used to establish consensus for each statement.

Results Sixteen nCLE-CS were discussed. Thirteen (81 %) nCLE-CS reached consensus addressing indications (non-communication PCL meeting criteria for EUS-FNA or with prior non-diagnostic EUS-FNA), diagnostic outcomes (improved accuracy for mucinous PCLs and serous cystadenomas with substantial interobserver agreement of image patterns), low incidence of adverse events (fluorescein-associated and pancreatitis), procedural processes (nCLE duration, manipulation of needle with probe), and training (physician knowledge and competence).

Conclusion Based on a high level of agreement pertaining to expert consensus statements, this report standardizes the practice of EUS-nCLE. EUS-nCLE should be systematically considered when EUS-FNA is indicated for PCL evaluation.

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