title: First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos).
abstract: BACKGROUND
  Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle.
  
  
  OBJECTIVE
  To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions.
  
  
  METHODS
  Feasibility study.
  
  
  METHODS
  Multicenter, tertiary care.
  
  
  METHODS
  Eighteen patients presenting for EUS-FNA.
  
  
  METHODS
  Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle.
  
  
  METHODS
  Device integrity, technical ease, safety, and image acquisition.
  
  
  RESULTS
  Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization.
  
  
  CONCLUSIONS
  Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images.
  
  
  CONCLUSIONS
  nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.
authors.affiliation: Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
authors.forename: Vani J A
authors.initials: VJ
authors.lastname: Konda
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Uzma D
authors.initials: UD
authors.lastname: Siddiqui
authors.forename: John
authors.initials: J
authors.lastname: Hart
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
mesh_terms: D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D005260:Female; D019793:Fluorescein; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000295:instrumentation*; D008875:Middle Aged; D010181:Pancreatic Cyst / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010195:Pancreatitis / Q000209:etiology; D018084:Ultrasonography, Interventional / Q000009:adverse effects
chemical_list: D019793:Fluorescein