CONFOCAL LASER ENDOMICROSCOPY FOR PANCREATOBILIARY DISEASES

Abstract

Confocal laser endomicroscopy (CLE) is used as a magnifying endoscopy for gastrointestinal diseases, and recently its application has expanded into pancreatobiliary diseases, such as indeterminate biliary stricture and pancreatic cystic neoplasms. CLE in pancreatobiliary diseases is performed via insertion of miniature CLE probes through a catheter or needle under ERCP or EUS guidance. Characteristic findings are reported for indeterminate biliary stricture and pancreatic cystic neoplasm diagnosis. A recent study demonstrated the diagnostic yield of CLE for determining the grade of dysplasia in intraductal papillary mucinous neoplasm. The role of peroral cholangioscopy (POCS) and EUS-guided through-the-needle biopsy (EUS-TTNB) is being reported increasingly in this field; thus, the comparison and/or combination with these other modalities should be further evaluated. Despite its cost and the limited approval of CLE by the Japanese insurance system, the role of CLE needs to be established via large-scale clinical trials.