title: Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management.
abstract: BACKGROUND
  Confocal endomicroscopy provides real-time evaluation of various sites and has been used to provide detailed endomicroscopic imaging of the biliary tree. We aimed to evaluate the feasibility and utility of probe-based confocal laser endomicroscopy of the pancreatic duct as compared to cytologic and histologic results in patients with indeterminate pancreatic duct strictures.
  
  
  METHODS
  Retrospective data on patients with indeterminate pancreatic strictures undergoing endoscopic retrograde cholangiopancreatography (ERCP) and confocal endomicroscopy were collected from two tertiary care centres. Real-time confocal endomicroscopy images were obtained during ERCP and immediate interpretation according to the Miami Classification was performed.
  
  
  RESULTS
  18 patients underwent confocal endomicroscopy for evaluation of pancreatic strictures from July 2011 to December 2012. Mean pancreatic duct size was 4.2mm (range 2.2-8mm). Eight cases were interpreted as benign, 4 as malignant, 4 suggestive of intraductal papillary mucinous neoplasms, and 2 appeared normal. Cytology/histopathology for 15/16 cases showed similar results to confocal endomicroscopy interpretation. Kappa coefficient of agreement between cyto/histopathology and confocal endomicroscopy was 0.8 (p=0.0001). Pancreatic confocal endomicroscopy changed management in four patients, changing the type of surgery from total pancreatectomy to whipple.
  
  
  CONCLUSIONS
  Confocal endomicroscopy is effective in assisting with diagnosis of indeterminate pancreatic duct strictures as well as mapping of abnormal pancreatic ducts prior to surgery.
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States. Electronic address: mkahaleh@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Turner
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Karl
authors.initials: K
authors.lastname: Bezak
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Reem Z
authors.initials: RZ
authors.lastname: Sharaiha
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Savreet
authors.initials: S
authors.lastname: Sarkaria
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Lieberman
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Armeen
authors.initials: A
authors.lastname: Jamal-Kabani
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Millman
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Subha V
authors.initials: SV
authors.lastname: Sundararajan
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Ching
authors.initials: C
authors.lastname: Chan
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Shivani
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Widmer
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Department of Gastroenterology, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D012189:Retrospective Studies
keywords: Confocal endomicroscopy; Intraductal papillary mucinous neoplasms; Pancreatic strictures; pCLE