EUS-Guided Needle-Based Confocal Laser Endomicroscopy: A Novel Technique With Emerging Applications.
Endoscopic ultrasound (EUS) has emerged as an excellent tool for imaging the gastrointestinal tract, as well as surrounding structures. EUS-guided fine-needle aspiration (EUS-FNA) has become the standard of care for the tissue sampling of a variety of masses and lymph nodes within and around the gut, providing further diagnostic and staging information. Confocal laser endomicroscopy (CLE) is a novel endoscopic method that enables imaging at a subcellular level of resolution during endoscopy, allowing up to 1000-fold magnification of tissue and providing an optical biopsy. A new procedure that has been developed in the past few years is needle-based confocal laser endomicroscopy (nCLE), which involves a mini-CLE probe that can be passed through a 1 9-gauge needle during EUS-FNA. This enables the real-time visualization of tissue at a microscopic level, with the potential to further improve the diagnostic accuracy of EUS-FNA. The device has been studied in animals as well as in humans, and the results so far have been promising. Recently, this method has also been used for the visualization of regulatory proteins and receptors in the pancreas, setting a cornerstone for nCLE in molecular imaging. The aim of this article is to review the role of EUS-guided nCLE in modern endoscopy and its implications in molecular imaging.
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Manoop S
MS
Bhutani
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Pramoda
P
Koduru
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Virendra
V
Joshi
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
John G
JG
Karstensen
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Adrian
A
Saftoiu
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Peter
P
Vilmann
Dr Bhutani is a professor and Dr Koduru is a research intern in the Department of Gastroenterology, Hepatology, and Nutrition at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr Joshi is an associate professor in the Department of Gastroenterology at the Ochsner Clinic Foundation in New Orleans, Louisiana. Dr Karstensen is a research fellow, Dr Saftoiu is a visiting professor, and Dr Vilmann is a professor at the University of Copenhagen Herlev Hospital in Herlev, Denmark. Dr Saftoiu is also a professor at the Research Center of Gastroenterology and Hepatology at the University of Medicine and Pharmacy of Craiova in Craiova, Romania. Dr Giovannini is a professor at the Institut Paoli-Calmettes in Marseille, France.
Marc
M
Giovannini
Endoscopic ultrasound; endosonography; intraductal papillary mucinous neoplasm; needle-based confocal laser endomicroscopy; pancreatic cystic neoplasm; serous cystadenoma