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World J Gastroenterol. Jun 14, 2019; 25(22): 2734-2742
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2734
Advanced diagnostics for pancreatic cysts: Confocal endomicroscopy and molecular analysis
Claire Durkin, Somashekar G Krishna
Claire Durkin, Somashekar G Krishna, Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University College of Medicine, Columbus, OH 43210, United States
Author contributions: Durkin C performed research and wrote the review article. Krishna SG performed research, wrote the review article, and finalized the paper.
Conflict-of-interest statement: The authors disclose no conflicts of interest.
Open-Access: This is an open-access article that 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/
Corresponding author: Somashekar G Krishna, MD, Associate Professor, Doctor, Sections of Pancreatic Disorders and Advanced Endoscopy, Division of Gas-troenterology, Hepatology and Nutrition, The Ohio State University College of Medicine, 395 W. 12th Avenue, Suite 262, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Telephone: +1-614-2936255 Fax: +1-614-2938518
Received: February 6, 2019
Peer-review started: February 6, 2019
First decision: February 26, 2019
Revised: April 29, 2019
Accepted: May 8, 2019
Article in press: May 8, 2019
Published online: June 14, 2019
Abstract

Technological advances and the widespread use of medical imaging have led to an increase in the identification of pancreatic cysts in patients who undergo cross-sectional imaging. Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Accurate diagnosis is crucial for guiding how a pancreatic cyst is managed, whether with surveillance for low-risk lesions or surgical resection for high-risk lesions. This review aims to summarize the current literature on confocal endomicroscopy and cyst fluid molecular analysis for the evaluation of pancreatic cysts. These recent technologies are promising adjuncts to existing approaches with the potential to improve diagnostic accuracy and ultimately patient outcomes.

Keywords: Pancreatic cysts, Confocal endomicroscopy, Molecular analysis, Molecular biomarkers, Pancreatic cancer

Core tip: Current methods for the diagnosis and risk-stratification of pancreatic cysts are suboptimal, resulting in both unnecessary surgical resection and overlooked cases of neoplasia. Novel technologies such as confocal endomicroscopy and cyst fluid molecular analysis are promising adjuncts to the existing standard of care for the management of pancreatic cysts with the potential to improve diagnostic accuracy and ultimately patient outcomes.