Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2022; 14(3): 129-141
Published online Mar 16, 2022. doi: 10.4253/wjge.v14.i3.129
Endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions: A single-center study
Carlos Robles-Medranda, Juan I Olmos, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Martha Arevalo-Mora, Raquel Del Valle Zavala, Joao Autran Nebel, Daniel Calle Loffredo, Hannah Pitanga-Lukashok
Carlos Robles-Medranda, Juan I Olmos, Miguel Puga-Tejada, Roberto Oleas, Jorge Baquerizo-Burgos, Martha Arevalo-Mora, Raquel Del Valle Zavala, Joao Autran Nebel, Daniel Calle Loffredo, Hannah Pitanga-Lukashok, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil 090505, Ecuador
Author contributions: Robles-Medranda C contributed to study conception, design, drafting; Olmos JI, Del Valle Zavala R, Nebel JA, Calle Loffredo D and Pitanga-Lukashok H contributed to study design, acquisition of data; Puga-Tejada M and Oleas R contributed to study design; Baquerizo-Burgos J, Puga-Tejada M and Oleas R contributed to study drafting, acquisition/analysis of data; Arevalo-Mora M did final database study consolidation and encryption, data acquisition; Robles-Medranda C, Olmos JI, Del Valle Zavala R, Nebel JA, Calle Loffredo D, Pitanga-Lukashok H, Puga-Tejada M, Oleas R and Arevalo-Mora M contributed to critical revision of important intellectual content; all authors did final approval of the version to be published.
Institutional review board statement: The study was approved by the Institutional Review Board of Instituto Ecuatoriano de Enfermedades Digestivas.
Informed consent statement: All study participants, and their legal guardians, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: Robles-Medranda C reports other from Pentax Medical, other from Boston Scientific, other from Steris, other from Medtronic, other from Motus, other from Micro-tech, other from G-Tech Medical Supply, other from CREO Medical, other from Mdconsgroup, outside the submitted work; The other authors declare no conflicts of interest.
Data sharing statement: The data that support the findings of this study are openly available by contacting the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article 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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlos Robles-Medranda, FASGE, MD, Chief Doctor, Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Av. Abel Romero Castillo y Av. Juan Tanca Marengo, Torre Vitalis, Mezanine 3, Guayaquil 090505, Ecuador. carlosoakm@yahoo.es
Received: July 27, 2021
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

In our study, EUS-guided mFB combined with nCLE, improve malignancy detection in patients with PCLs.

Research perspectives

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.