Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study

Gastrointest Endosc. 2015 May;81(5):1204-14. doi: 10.1016/j.gie.2014.10.025. Epub 2015 Jan 26.


Background: The diagnosis of pancreatic cystic neoplasms (PCNs), which now depends on morphology, cytology, and fluid analysis, is still challenging. A novel confocal laser endomicroscopy probe that can be inserted through a 19-gauge FNA needle allows needle-based confocal laser endomicroscopy (nCLE), and the feasibility of nCLE has been reported in PCNs. The combination of cystoscopy by using a through-the-needle fiberoptic probe in combination with nCLE under EUS guidance may improve the diagnosis of PCNs.

Objective: To assess the feasibility, safety, and diagnostic yield of the combination of cystoscopy and nCLE in the clinical diagnosis of PCNs.

Design: A prospective feasibility study.

Setting: An academic tertiary referral center.

Patients: Thirty patients with PCNs.

Interventions: EUS-guided dual through-the-needle imaging (cystoscopy and nCLE) for PCNs.

Main outcome measurements: Technical feasibility and safety. Associations of cystoscopy and nCLE findings with clinical diagnosis of PCNs.

Results: The procedure was technically successful with the exception of 1 probe exchange failure. In 2 patients (7%), postprocedure pancreatitis developed. Specific features associated with the clinical diagnosis of mucinous cysts were identified: mucin on cystoscopy and papillary projections and dark rings on nCLE. The sensitivity of cystoscopy was 90% (9/10), and that of nCLE was 80% (8/10), and the combination was 100% (10/10) in 18 high-certainty patients.

Limitations: A single-center study and lack of complete pathologic correlation.

Conclusion: The combination of dual through-the-needle imaging (cystoscopy and nCLE) of pancreatic cysts appears to have strong concordance with the clinical diagnosis of PCN. (

Clinical trial registration number: NCT01447238.).

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Microscopy, Confocal
  • Middle Aged
  • Pancreatic Neoplasms / diagnostic imaging*
  • Pancreatic Neoplasms / pathology*
  • Prospective Studies

Associated data

  • ClinicalTrials.gov/NCT01447238