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ORIGINAL ARTICLE
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Efficacy of EUS-guided needle-based confocal laser endomicroscopy in the diagnosis of pancreatic lesions: A systematic review and meta-analysis


1 Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
2 Department of Internal Medicine, Roger Williams Medical Center, Providence, RI, USA
3 Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
4 Department of Biostatistics and Epidemiology, University of Nevada, Las Vegas, NV, USA
5 Department of Gastroenterology and Hepatology, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
6 Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, UT, USA

Correspondence Address:
Douglas G Adler,
Huntsman Cancer Center, University of Utah School of Medicine, 30 N 1900 E, Room 4R118, Salt Lake City, UT 84132
USA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-20-00122

PMID: 33666181

Background and Objectives: Needle-based confocal laser endomicroscopy (nCLE) is a procedure in which an AQ-Flex nCLE mini-probe is passed through an EUS-FNA needle into a pancreatic lesion to enable subsurface in vivo tissue analysis. In this study, we conducted a systematic review and meta-analysis of nCLE for the diagnosis of pancreatic lesions. Materials and Methods: We conducted a comprehensive search of several databases and conference proceedings, including PubMed, EMBASE, Google-Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to March 2020). The primary outcomes assessed the pooled rate of diagnostic accuracy for nCLE and the secondary outcomes assessed the pooled rate of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and adverse events (AE) of nCLE to diagnose premalignant/malignant pancreatic lesions. Results: Eleven studies on 443 patients were included in our analysis. The pooled rate of diagnostic accuracy of EUS nCLE was 83% (95 confidence interval [CI] = 79–87; I 2 = 0). The pooled rate of sensitivity, specificity, PPV and NPV of EUS nCLE was 85.29% (95% CI = 76.9–93.68; I 2 = 85%), 90.49% (95% CI = 82.24–98.74; I 2 = 64%), 94.15% (95% CI = 88.55–99.76; I 2 = 68%), and 73.44% (95% CI = 60.16–86.72; I 2 = 93%), respectively. The total AE rate was 5.41% (±5.92) with postprocedure pancreatitis being the most common AE at 2.28% (±3.73). Conclusion: In summary, this study highlights the rate of diagnostic accuracy, sensitivity, specificity, and PPV for distinguishing premalignant/malignant lesions. Pancreatic lesions need to be further defined with more validation studies to characterize CLE diagnosis criteria and to evaluate its use as an adjunct to EUS-FNA.


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