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
 1   Département de Gastroentérologie, Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
Somashekar G. Krishna
 2   Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
Bruno Marco
 3   Department of Gastroenterology & Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands
David Carr-Locke
 4   The Center for Advanced Digestive Care, Weill Cornell Medicine, New York Presbyterian Hospital, New York, United States
Kenneth J. Chang
 5   Gastroenterology and Hepatology Division, H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, California, United States
Àngels Ginès
 6   Endoscopy Unit. Department of Gastroenterology. Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona. Catalunya, Spain
Frank G. Gress
 7   Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, United States
Alberto Larghi
 8   Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
Kofi W. Oppong
 9   Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
Laurent Palazzo
10   Clinique du Trocadéro, Paris, France
Pradermchai Kongkam
11   Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Carlos Robles-Medranda
12   Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador
Divyesh Sejpal
13   Division of Gastroenterology, Department of Medicine, Hofstra Northwell School of Medicine, Northwell Health System, North Shore University Hospital, Manhasset, New York, United States
Damien Tan
14   Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
William R. Brugge
15   Division of Gastroenterology Mount Auburn Hospital Cambridge, Massachusetts, United States
› Author Affiliations


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.

Publication History

Received: 25 March 2020

Accepted: 18 May 2020

Article published online:
22 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

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