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Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
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Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral
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Clin Endosc 2022;55(2):197-207. Published online November 29, 2021
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DOI: https://doi.org/10.5946/ce.2021.079
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 Abstract
 PDF PubReader ePub
- Background
/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliary disorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnostic performance of confocal laser endomicroscopy (CLE).
Methods
We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of the technique, image classification, diagnostic performance, ongoing research, and limitations.
Results
Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). Needlebased CLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma, neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobserver variability are challenges for routine utilization.
Conclusions
CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs and simplifying image interpretation will promote utilization by advanced endoscopists.
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Citations
Citations to this article as recorded by  - Updates in Diagnosis and Endoscopic Management of Cholangiocarcinoma
Roxana-Luiza Caragut, Madalina Ilie, Teodor Cabel, Deniz Günșahin, Afrodita Panaitescu, Christopher Pavel, Oana Mihaela Plotogea, Ecaterina Mihaela Rînja, Gabriel Constantinescu, Vasile Sandru
Diagnostics.2024; 14(5): 490. CrossRef - Endoscopic Ultrasound-Guided Needle-Based Confocal Endomicroscopy as a Diagnostic Imaging Biomarker for Intraductal Papillary Mucinous Neoplasms
Shreyas Krishna, Ahmed Abdelbaki, Phil A. Hart, Jorge D. Machicado
Cancers.2024; 16(6): 1238. CrossRef - Exploring Intestinal Permeability: Concept, Diagnosis, Connection to Bowel Disease, and Iron Deficiency
Olesja Basina, Aleksejs Derovs, Jeļena Derova, Sandra Lejniece
Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences..2024; 78(4): 244. CrossRef - American Society for Gastrointestinal Endoscopy guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: summary and recommendations
Larissa L. Fujii-Lau, Nirav C. Thosani, Mohammad Al-Haddad, Jared Acoba, Curtis J. Wray, Rodrick Zvavanjanja, Stuart K. Amateau, James L. Buxbaum, Audrey H. Calderwood, Jean M. Chalhoub, Nayantara Coelho-Prabhu, Madhav Desai, Sherif E. Elhanafi, Douglas S
Gastrointestinal Endoscopy.2023; 98(5): 685. CrossRef - In Vivo Click Chemistry Enables Multiplexed Intravital Microscopy
Jina Ko, Kilean Lucas, Rainer Kohler, Elias A. Halabi, Martin Wilkovitsch, Jonathan C. T. Carlson, Ralph Weissleder
Advanced Science.2022;[Epub] CrossRef - Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling
Woo Hyun Paik
International Journal of Gastrointestinal Intervention.2022; 11(3): 96. CrossRef
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Impact of Periampullary Diverticulum on ERCP Performance: A Matched Case-Control Study
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Juan E. Corral, Omar Y. Mousa, Paul T. Kröner, Victoria Gomez, Frank J. Lukens
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Clin Endosc 2019;52(1):65-71. Published online August 21, 2018
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DOI: https://doi.org/10.5946/ce.2018.070
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Abstract
PDFPubReaderePub
- Background
/Aims: Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrograde cholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls.
Methods
We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age- and gendermatched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease.
Results
The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls.
Conclusions
PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.
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Citations
Citations to this article as recorded by - Development of a Scoring System for Predicting the Difficulty of Bile Duct Cannulation and Selecting the Appropriate Cannulation Method
Taira Kuroda, Hideki Miyata, Kozue Kanemitsu-Okada, Emi Yanagihara, Hironobu Saneto, Taisei Murakami, Hirofumi Izumoto, Kei Onishi, Shogo Kitahata, Tomoe Kawamura, Ryuichiro Iwasaki, Fujimasa Tada, Eiji Tsubouchi, Atsushi Hiraoka, Tomoyuki Ninomiya
Digestive Diseases and Sciences.2025; 70(2): 843. CrossRef - Effect of periampullary diverticulum morphology on ERCP cannulation and clinical results
Yavuz Cagir, Muhammed Bahaddin Durak, Cem Simsek, Ilhami Yuksel
Scandinavian Journal of Gastroenterology.2025; 60(4): 292. CrossRef - Association of periampullary diverticulum types with post-ERCP hyperamylasemia: a retrospective observational study
Serdar Akca, Galip Egemen Atar, Serkan Ocal, Osman Cagin Buldukoglu, Gokhan Koker, Muhammed Devran Isik, Besir Kaya, Hatice Deniz, Ferda Akbay Harmandar, Ayhan Hilmi Cekin
BMC Gastroenterology.2025;[Epub] CrossRef - The impact of periampullary diverticula on cannulation and adverse events in endoscopic retrograde cholangiopancreatography
Arvid Gustafsson, Bobby Tingstedt, Greger Olsson
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef - Impact of periampullary diverticula on the rates of successful cannulation and ERCP complications: An up‐to‐date systematic review and meta‐analysis
Xiao Xi Xie, Xiao Li, Yong Hao Chen, Chong Geng, Chun Hui Wang
Journal of Digestive Diseases.2024; 25(9-10): 573. CrossRef - Impact of periampullary diverticulum on biliary cannulation: A retrospective cohort study
Jing Liang Ho, Aruni Seneviratna, Cherng Hann Benjamin Yip
Advances in Digestive Medicine.2023; 10(4): 232. CrossRef - A new classification of periampullary diverticulum: cannulation of papilla on the inner margins of the diverticulum (Type IIa) is more challenging
He-xian Shi, Yong-qiang Ye, Hai-wang Zhao, De-cai Kong, Shan-zhou Huang, Qian Yan, Yu-bin Chen, Ping Zhang, Sheng Chen, Bao-hua Hou, Chuan-zhao Zhang
BMC Gastroenterology.2023;[Epub] CrossRef - Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation
Ping Yue, Ke-Xiang Zhu, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
World Journal of Gastroenterology.2020; 26(19): 2402. CrossRef - Clinical significance of different periampullary diverticulum classifications for endoscopic retrograde cholangiopancreatography cannulation
Ping Yue, Ke-Xiang Zhu, Hai-Ping Wang, Wen-Bo Meng, Jian-Kang Liu, Lei Zhang, Xiao-Liang Zhu, Hui Zhang, Long Miao, Zheng-Feng Wang, Wen-Ce Zhou, Azumi Suzuki, Kiyohito Tanaka, Xun Li
World Journal of Gastroenterology.2020; 26(19): 2403. CrossRef - Periampüller divertikül endoskopik retrograd kolanjiyopankreatografide kanülasyon başarısı ve komplikasyon sıklığını etkiler mi?
Bilal TOKA, Salih TOKMAK
Akademik Gastroenteroloji Dergisi.2020; 19(2): 83. CrossRef - Complications increase in which type of duodenal diverticulum? A retrospective cohort study
Murat AKAYDIN, Tamer AKAY, Metin LEBLEBİCİ
Journal of Surgery and Medicine.2020; 4(11): 938. CrossRef - Presence of Periampullary Diverticulum is Not a Hurdle to Successful Endoscopic Retrograde Cholangiopancreatography
Jimin Han
Clinical Endoscopy.2019; 52(1): 7. CrossRef - ERCP Success Rate and Periampullary Diverticula: The Pocket Makes No Difference
Gyanprakash Ketwaroo, Waqar Qureshi
Digestive Diseases and Sciences.2019; 64(5): 1072. CrossRef
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