Endoscopy 2018; 50(11): 1089-1094
DOI: 10.1055/a-0631-1634
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Volumetric laser endomicroscopy in the biliary and pancreatic ducts: a feasibility study with histological correlation

Juan E. Corral
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Omar Y. Mousa
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Murli Krishna
2  Division of Pathology, Mayo Clinic, Jacksonville, Florida, USA
,
Iris J. M. Levink
3  Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Khela R. Pursell
2  Division of Pathology, Mayo Clinic, Jacksonville, Florida, USA
,
Mohammad Afsh
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Paul T. Kröner
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Denise M. Harnois
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Herbert C. Wolfsen
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Michael B. Wallace
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
,
Frank J. Lukens
1  Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
› Author Affiliations
Further Information

Publication History

submitted 13 January 2018

accepted after revision 19 April 2018

Publication Date:
18 June 2018 (eFirst)

Abstract

Background Volumetric laser endomicroscopy (VLE) provides circumferential images 3 mm into the biliary and pancreatic ducts. We aimed to correlate VLE images with the normal and abnormal microstructure of these ducts.

Methods: Samples from patients undergoing hepatic or pancreatic resection were evaluated. VLE images were collected using a low-profile VLE catheter inserted manually into the biliary and pancreatic ducts ex vivo. Histological correlation was assessed by two unblinded investigators.

Results 25 patients (20 liver and 5 pancreatic samples) and 111 images were analyzed. VLE revealed three histological layers: epithelium, connective tissue, and parenchyma. It identified distinctive patterns for primary sclerosing cholangitis (PSC), pancreatic cysts, neuroendocrine tumor, and adenocarcinoma adjacent to the pancreatic duct or ampulla. VLE failed to identify dysplasia in a dominant stricture and inflammatory infiltrates in PSC. Reflectivity measurements of the liver parenchyma diagnosed liver cirrhosis with high sensitivity.

Conclusions VLE can identify histological changes in the biliary and pancreatic ducts allowing real-time diagnosis. Further studies are needed to measure the accuracy of VLE in a larger sample and to validate our findings in vivo.

Appendix e1, Fig. e1, Table e1 – e4