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World J Gastrointest Endosc. Jan 16, 2018; 10(1): 1-9
Published online Jan 16, 2018. doi: 10.4253/wjge.v10.i1.1
Confocal endomicroscopy and cyst fluid molecular analysis: Comprehensive evaluation of pancreatic cysts
Feng Li, Ahmad Malli, Zobeida Cruz-Monserrate, Darwin L Conwell, Somashekar G Krishna
Feng Li, Ahmad Malli, Zobeida Cruz-Monserrate, Darwin L Conwell, Somashekar G Krishna, Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Li F contributed to conception, design, drafting of the article and critical revision of the article for important intellectual content; Malli A contributed to critical revision of the article for important intellectual content; Cruz-Monserrate Z contributed to critical revision of the article for important intellectual content; Conwell DL contributed to critical revision of the article for important intellectual content; Krishna SG contributed to conception, design, drafting of the article, critical revision of the article for important intellectual content and final approval of the article.
Conflict-of-interest statement: There are no relevant conflicts of interest to report for any author.
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: Dr. Somashekar G Krishna, MD, Assistant Professor, Doctor, Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, 395 W. 12th Avenue, 2nd floor Office Tower, Columbus, OH 43210, United States. somashekar.krishna@osumc.edu
Telephone: +1-614-2936255 Fax: +1-614-2930861
Received: November 14, 2017
Peer-review started: November 17, 2017
First decision: December 6, 2017
Revised: December 11, 2017
Accepted: December 29, 2017
Article in press: December 29, 2017
Published online: January 16, 2018
Abstract

Increases in the quality as well as utilization of cross-sectional imaging have led to rising diagnoses of pancreatic cystic lesions (PCL). Accurate presurgical diagnosis enables appropriate triage of PCLs. Unfortunately, current diagnostic approaches have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. Additionally, early detection represents an opportunity for intervention to prevent the progression to pancreatic adenocarcinoma. Our aim for this review is to systematically review the current literature on confocal endomicroscopy and molecular biomarkers in the evaluation of PCLs. Confocal laser endomicroscopy is a novel technology that allows for real-time in vivo microscopic imaging with multiple clinical trials identifying characteristic endomicroscopy findings of various pancreatic cystic lesions. DNA-based molecular markers have also emerged as another diagnostic modality as the pattern of genetic alternations present in cyst fluid can provide both diagnostic and prognostic data. We propose that both techniques can be utilized to improve patient outcomes.

Keywords: Pancreas, Pancreatic cyst, Pancreatic adenocarcinoma, Confocal endomicroscopy, Next generation sequencing, Molecular marker

Core tip: Current diagnostic guidelines for the evaluation of pancreatic cystic lesions have suboptimal accuracy and may lead to unnecessary surgical resections or missed diagnoses of advanced neoplasia. We propose that two new diagnostic technologies, confocal laser endomicroscopy and DNA-based molecular markers, may be used synergistically to improve diagnostic accuracy. In this review, we summarize the current literature regarding these two techniques.