Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12696-12708
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12696
Probe based confocal laser endomicroscopy of the pancreatobiliary system
Majid A Almadi, Helmut Neumann
Majid A Almadi, Division of Gastroenterology, Department of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
Majid A Almadi, Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal H3G 1A4, Canada
Helmut Neumann, Department of Medicine I, University of Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
Author contributions: Almadi MA contributed to the concept of the manuscript, study design and acquisition of data, interpretation of data, drafted the manuscript, final revisions and made the final approval; and Neumann H contributed to concept of the manuscript, study design, interpretation of data, made revisions and made the final approval.
Supported by Deanship of Scientific Research at King Saud University through the Research Group Project number RGP-VPP-279.
Conflict-of-interest statement: Majid A Almadi: “No relevant conflicts of interest exist”; Helmut Neumann: Consultant for Pentax, Mauna Kea Technologies, SpectraScience; Funding from Pentax, SpectraScience, Olympus, Siemens, Smart Medical, Fujifilm.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Majid A Almadi, MBBS, FRCPC, MSc, Assistant Professor, Division of Gastroenterology, Department of Medicine, King Saud University Medical City, King Saud University, PO Box 2925 (59), Riyadh 11461, Saudi Arabia. maalmadi@ksu.edu.sa
Telephone: +966-11-4679167 Fax: +966-11-4671217
Received: March 28, 2015
Peer-review started: March 29, 2015
First decision: June 19, 2015
Revised: July 8, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: November 28, 2015
Processing time: 244 Days and 12.4 Hours
Abstract

AIM: To review applications of confocal laser endomicroscopy (CLE) in pancreatobiliary lesions and studies that assessed training and interpretation of images.

METHODS: A computerized literature search was performed using OVID MEDLINE, EMBASE, Cochrane library, and the ISI Web of Knowledge from 1980 to October 2014. We also searched abstracts from major meetings that included the Digestive Disease Week, Canadian Digestive Disease Week and the United European Gastroenterology Week using a combination of controlled vocabulary and text words related to pCLE, confocal, endomicroscopy, probe-based confocal laser endomicroscopy, and bile duct to identify reports of trials. In addition, recursive searches and cross-referencing was performed, and manual searches of articles identified after the initial search was also completed. We included fully published articles and those in abstract form. Given the relatively recent introduction of CLE we included randomized trials and cohort studies.

RESULTS: In the evaluation of indeterminate pancreatobiliary strictures CLE with ERCP compared to ERCP alone can increase the detection of cancerous strictures with a sensitivity of (98% vs 45%) and has a negative predictive value (97% vs 69%), but decreased the specificity (67% vs 100%) and the positive predictive value (71% vs 100%) when compared to index pathology. Modifications in the classification systems in indeterminate biliary strictures have increased the specificity of pCLE from 67% to 73%. In pancreatic cystic lesions there is a need to develop similar systems to interpret and characterize lesions based on CLE images obtained. The presence of superficial vascular network predicts serous cystadenomas accurately. Also training in acquiring and interpretation of images is feasible in those without any prior knowledge in CLE in a relatively simple manner and computer-aided diagnosis software is a promising innovation.

CONCLUSION: The role of pCLE in the evaluation of pancreatobiliary disorders might be better suited for those with an intermediate and low probability.

Keywords: Probe based confocal laser endomicroscopy, Confocal, Endomicroscopy, Probe-based confocal laser endomicroscopy, Bile duct, Pancreatobiliary, Stricture, Endoscopic retrograde cholangiopancreatography, Cholangioscopy, Endoscopic ultrasound, Systematic review

Core tip: Current endoscopic evaluation of biliary and pancreatic duct strictures and pancreatic lesions using standard methods are suboptimal. Confocal laser endomicroscopy (CLE) is starting to establish a role in such cases with multiple studies suggesting that image interpretation is not as difficult as initially perceived. Furthermore the diagnostic discriminatory value of images obtained by CLE could decrease the need for repeated and invasive investigations, as the case in the serous cystadenomas. Although classification systems have been developed and improved with regards to the performance of CLE in biliary strictures they are still evolving for pancreatic lesions and require further validation.