Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2018; 24(26): 2853-2866
Published online Jul 14, 2018. doi: 10.3748/wjg.v24.i26.2853
New horizons in the endoscopic ultrasonography-based diagnosis of pancreatic cystic lesions
María-Victoria Alvarez-Sánchez, Bertrand Napoléon
María-Victoria Alvarez-Sánchez, Instituto de Investigación Sanitaria Galicia Sur, Complejo Hospitalario Universitario de Pontevedra, Pontevedra 36003, Spain
Bertrand Napoléon, Department of Gastroenterology, Ramsay Générale de Santé Private Hospital Jean Mermoz, Lyon 69008, France
Author contributions: Alvarez-Sánchez MV and Napoléon B contributed equally to reviewing the literature, writing and drafting the article, critical revision and final approval.
Conflict-of-interest statement: María-Victoria Alvarez-Sánchez has no conflicts of interest or financial ties to disclose. Bertrand Napoléon received educational fees from Boston Scientific SA and Mauna Kea Technologies.
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:
Correspondence to: María-Victoria Alvarez-Sánchez, MD, Attending Doctor, Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Avenida de Mourente sn, Pontevedra 36003, Spain.
Telephone: +34-986-800907 Fax: +34-986-800309
Received: March 28, 2018
Peer-review started: March 29, 2018
First decision: April 27, 2018
Revised: May 28, 2018
Accepted: June 16, 2018
Article in press: June 16, 2018
Published online: July 14, 2018

Pancreatic cystic lesions (PCLs) are increasingly being identified because of the widespread use of high-resolution abdominal imaging. These cysts encompass a spectrum from malignant disease to benign lesions, and therefore, accurate diagnosis is crucial to determine the best management strategy, either surgical resection or surveillance. However, the current standard of diagnosis is not accurate enough due to limitations of imaging and tissue sampling techniques, which entail the risk of unnecessary burdensome surgery for benign lesions or missed opportunities of prophylactic surgery for potentially malignant PCLs. In the last decade, endoscopic innovations based on endoscopic ultrasonography (EUS) imaging have emerged, aiming to overcome the present limitations. These new EUS-based technologies are contrast harmonic EUS, needle-based confocal endomicroscopy, through-the-needle cystoscopy and through-the needle intracystic biopsy. Here, we present a comprehensive and critical review of these emerging endoscopic tools for the diagnosis of PCLs, with a special emphasis on feasibility, safety and diagnostic performance.

Keywords: Intraductal papillary mucinous neoplasm, Pancreatic cystic lesions, Endoscopic ultrasonography, Confocal endomicroscopy, Mucinous cystadenoma, Through-the-needle cystoscopy, Serous cystadenoma, Through-the-needle forceps biopsy, Contrast harmonic endoscopic ultrasonography

Core tip: This paper provides a focused update on emerging endoscopic technologies for improving the diagnosis and prediction of the malignant potential of pancreatic cystic lesions. Basic principles, diagnostic performance, safety and limitations are critically reviewed.