Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.129
Peer-review started: July 27, 2021
First decision: November 11, 2021
Revised: December 15, 2021
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: March 16, 2022
Processing time: 232 Days and 0.9 Hours
Pancreatic cystic lesions (PCLs) incidence is rising mainly in elderly patients. Accurate diagnosing and appropriate management of patients with malignant PCLs, have a positive impact in regards of healthcare expenses and in patients’ quality of life.
Currently, there is insufficient data about the accuracy in the diagnosing of PCLs, especially with novel endoscopic techniques. Furthermore, the early detection of potentially malignant PCLs, increases the possibility of a curative approach in said patients.
Given the poor prognosis of malignant PCLs, attaining early detection, an accurate diagnosis, and determining the best diagnostic approach with newly available endoscopic techniques, was essential to this study.
This was a retrospective, single-center study. Patients were allocated to three evaluation cohorts: (1) Endoscopic ultrasound (EUS) alone; (2) EUS- fine needle aspiration, contrast-enhanced-EUS and/or EUS-guided fiberoptic probe cystoscopy (cystoscopy); and (3) EUS-guided direct intracystic micro-forceps biopsy (mFB) and EUS-guided needle-based confocal laser-endomicroscopy (nCLE); and compared the accuracy of these techniques for the detection of potentially malignant PCLs.
We described that pairing EUS, mFB, and nCLE, had a statistically significant improved detection of potentially malignant PCLs compared to any of the evaluated techniques alone. No adverse events were documented, and a 100% technical success rate was achieved.
In our study, EUS-guided mFB combined with nCLE, improve malignancy detection in patients with PCLs.
To define formal diagnostic and therapeutical guidelines, we encourage researchers to conduct long-term follow-up randomized multicenter and cost-benefit studies, comparing newly available endoscopic techniques for the assessment of PCLs.