Real-time guidance of lauromacrogol ablation for pancreatic cystic lesions using confocal laser endomicroscopy.

BACKGROUND

Needle-based confocal laser endomicroscopy (nCLE) can accurately identify the pathological types of pancreatic cystic lesions (PCLs), but there are no reports of real-time intraoperative guidance for lauromacrogol ablation (LA) therapy.

OBJECTIVES

This study aimed to assess the diagnostic accuracy and safety of nCLE in identifying the candidates for LA in the same session as endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).

DESIGN

Prospective study.

METHODS

We performed a prospective study of patients with PCL who underwent EUS-FNA and nCLE at the First Medical Center of Chinese PLA General Hospital between February 2024 and June 2025. The diagnostic performance of nCLE in intraoperatively differentiating concomitant ablation-eligible lesions (CAELs) from concomitant ablation-ineligible lesions (CAILs) was evaluated and compared with that of EUS morphology and the cyst fluid string sign.

RESULTS

A total of 29 patients were enrolled in the study, and the mean size of the cyst was 34.1 ± 12.5 mm. The mean duration of EUS-nCLE was 4.61 min. EUS-nCLE identified CAELs with 94% sensitivity, 77% specificity, and 86% accuracy. The diagnostic accuracy of nCLE was superior to that of EUS morphology and the string sign (86% vs 66%, p = 0.039). Postprocedural acute pancreatitis occurred in 2 of 29 patients (6.9%), and all episodes were mild according to the revised Atlanta classification.

CONCLUSION

Confocal laser endomicroscopy demonstrates favorable real-time diagnostic performance for PCLs, allowing accurate assessment of the suitability for ablation during puncture and thereby avoiding the need for a repeat procedure.