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.