Phonthep Angsuwatcharakon
Chulalongkorn University
Phonthep Angsuwatcharakon, MD, MSc1, Irina M. Cazacu, MD2, Ben S. Singh, BA2, Rungsun Rerknimitr, MD3, Pradermchai Kongkam, MD, MSc1, Manoop S. Bhutani, MD, FACG2
1Chulalongkorn University, Bangkok, Krung Thep, Thailand; 2University of Texas MD Anderson Cancer Center, Houston, TX; 3Gastrointestinal Endoscopy Excellence Center, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Pathumwan, Krung Thep, Thailand
Introduction: EUS-guided needle-based confocal laser endomicroscopy (nCLE) provides real-time histology assessments and has been reported as an adjunctive tool that can be performed in the same session as EUS-fine needle aspiration. We aimed to perform a systematic review and meta-analysis regarding the diagnostic performance, success rate, and complications of nCLE in pancreas cysts.
Methods: This is a systematic review and meta-analysis following the PRISMA-P principles. Literature was systematically searched in February 2019 by two independent investigators in 3 major databases including PubMed, Embase, and Web of Science by using the terms ‘confocal endomicroscopy’ AND ‘needle’ AND ‘pancreas cyst’. The search was limited to English-written and in vivo human studies. Additionally, investigators manually reviewed the references of the primary identified studies for other eligible articles. The meta-analysis of success rate, complication rate, pooled diagnostic parameters with the respective 95% confidence interval (CI) of nCLE for diagnosis of pancreas cysts were performed.
Results: Of the 159 initially screened studies, 11 studies had 288 patients with pancreatic cystic lesions enrolled. The estimated overall success rate and adverse event rate with random effects model were 96% (95% CI: 92-95%) and 11% (95% CI: 7.5-16%), respectively. There were 7 studies which included 176 patients that reported the diagnostic parameters of nCLE for diagnosis of mucinous pancreas cyst. The estimated diagnostic odd ratio (DOR) was 50 (95% CI: 18.92-132.16). The estimated area under curve (AUC) was 0.939 (95% CI: 0.89-0.992) and AUC for SROC was 0.84 (95% CI: 0.72-0.98). The estimate sensitivity and specificity were 0.77 (95% CI: 0.62-0.87) and 0.91 (95% CI: 0.81-0.96), respectively. The meta-analysis estimated the prevalence rate of mucinous cysts to be 57% (95% CI: 43%- 71%). The positive predictive value (PPV) and negative predictive value (NPV) were 0.91 (range: 0.86 – 0.95) and 0.72 (range: 0.62, 0.84), respectively. I2 index showed no heterogeneity between studies in success rate, adverse event rate, DOR, and specificity. However, heterogeneity was detected in sensitivity, PPV, and NPV between studies.
Discussion: nCLE has high sensitivity, specificity, PPV, and NPV for differentiating mucinous pancreas cyst from the other cystic lesion. However there is an increased adverse rate compared to standard EUS-FNA. Measures and methods to decrease the adverse event rate should be further investigated.
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Citation: Phonthep Angsuwatcharakon, MD, MSc; Irina M. Cazacu, MD; Ben S. Singh, BA; Rungsun Rerknimitr, MD; Pradermchai Kongkam, MD, MSc; Manoop S. Bhutani, MD, FACG. P0026 - NEEDLE-BASE CONFOCAL LASER ENDOMICROSCOPY IN THE DIAGNOSIS OF PANCREAS CYST: A SYSTEMATIC REVIEW AND META-ANALYSIS. Program No. P0026. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.