Review ArticlesNeedle-based confocal laser endomicroscopy in pancreatic cysts: a meta-analysisFacciorusso, Antonio; Buccino, Vincenzo Rosario; Sacco, RodolfoAuthor Information Department of medical sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy Received 21 November 2019 Accepted 22 February 2020 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.eurojgh.com. Correspondence to Antonio Facciorusso, MD, PhD, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, AOU Ospedali Riuniti, Viale Pinto, 1, 71100 Foggia, Italy, Tel: +0039 0881732110; fax: +0039 0881733545; e-mail: [email protected] European Journal of Gastroenterology & Hepatology: September 2020 - Volume 32 - Issue 9 - p 1084-1090 doi: 10.1097/MEG.0000000000001728 Buy SDC Metrics Abstract There is currently limited evidence supporting the use of needle-based confocal laser endomicroscopy in pancreatic cystic lesions. Aim of this study was to provide a pooled estimate of the diagnostic performance and safety profile of this technique in patients with pancreatic cysts. Computerized bibliographic search on the main databases was performed through November 2019. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy. Secondary outcomes were pooled sensitivity, specificity, and mean procedural time. Ten studies enrolling 536 patients were included. Eight articles, of which five prospective series, compared confocal laser endomicroscopy to cytology/cystic fluid analysis. Most patients were female and body/tail was the most frequent location of pancreatic cysts. Mucinous cysts were prevalent in most of the included studies. Diagnostic accuracy with confocal laser endomicroscopy was 88.6% (83.7–93.4%) and sensitivity analysis according to study quality, design, and treatment arms confirmed the above reported result. Pooled sensitivity and specificity were 82.4% (74.7–90.1%) and 96.6% (94.3–99%), respectively. Both accuracy and sensitivity resulted higher in patients with mucinous cysts (91.4 and 94.9%, respectively). Confocal laser endomicroscopy clearly outperformed fine-needle aspiration in terms of diagnostic accuracy (odds ratio 3.94, 1.58–9.82; P = 0.003). A mean of 6.094 minutes (4.91–7.26) was needed to complete the procedure and no significant adverse event was registered. Our meta-analysis speaks in favor of the use of needle-based confocal laser endomicroscopy as a safe and effective tool in the diagnostic algorithm of pancreatic cysts. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.