VHM12 Confocal Laser Endomicroscopy (CLE): Evaluation of Pancreatic Cystic Lesions In Vivo and Ex Vivo

Abstract

In this video we compare in vivo and ex vivo images of pancreatic cystic lesions as seen with confocal laser endomicroscopy (CLE). Three patient cases are presented, two whom underwent in vivo imaging of intra ductal papillary mucinous neoplasms (IPMN), and one that underwent pancreatectomy and examination of the resected IPMN lesion with ex vivo CLE imaging. For the in vivo imaging, endoscopic ultrasound with fine aspiration is first used to puncture the lining of the pancreatic cyst. The stylet is then withdrawn and a needle probe based confocal probe introduced through the needle. For the ex vivo imaging, confocal laser endomicroscopy was applied using an ultra high definition gastroflex probe (Cellvizio, Mauna Kea Tech) CLE is an imaging modality that, when used in adjunct to endoscopic ultrasound, may further help to distinguish the benign, pre malignant and malignant cystic lesions of the pancreas by visualizing the cellular lining of the cysts in vivo. The may prevent unnecessary surgery in patients with benign cysts and guide early and effective surgical removal of high risk neoplastic lesions. The in vivo and ex vivo images as viewed with confocal endomicroscopy support the hypothesis that the dark circumferential structures may represent the dysplastic papillae of IPMN.