New horizons in the endoscopic ultrasonography-based diagnosis of pancreatic cystic lesions

Abstract

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.