Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2026 Feb 3.
Published in final edited form as: Gastrointest Endosc. 2025 Jul 17;103(1):182–184. doi: 10.1016/j.gie.2025.07.010

Single-session real-time diagnosis and treatment of branch-duct intraductal papillary mucinous neoplasms

Matthew Yoder 1, Fadi Hawa 2, Ahmed Abdelbaki 3, Jennifer Rath 4, Zarine K Shah 5, Somashekar G Krishna 6
PMCID: PMC12863237  NIHMSID: NIHMS2134469  PMID: 40683361

A 75-year-old man with diabetes and previous kidney transplant was evaluated for a 4.6 × 4.4-cm pancreatic body cyst (A) that had increased from 3.7 × 3.3 cm over 3 years on serial computed tomography scans. Given his comorbidities, social circumstances, and the need to minimize repeated procedures, we combined real-time diagnosis and risk stratification using endoscopic ultrasound—guided needle-based confocal laser endomicroscopy (nCLE), with potential for same-session EUS-guided radiofrequency ablation (RFA) on the basis of findings.

EUS-nCLE with the AQ-Flex miniprobe (Cellvizio; Mauna Kea Technologies, Paris, France) revealed features of a branch duct intraductal papillary mucinous neoplasm with flat epithelium and monolayered nuclei, consistent with low-grade dysplasia (B). After cyst aspiration, EUS-RFA was performed using a 19-gauge EUSRA 10-mm probe (TaeWoong Medical, Los Angeles, Calif, USA) and the VIVA pump (STARmed American, Los Angeles, Calif, USA) at 50W in continuance mode. A total of 18 applications were delivered (mean: 41.3 seconds/application) (C).

The cyst volume decreased from 41.9 to 3 mL postablation, indicating a 91.6% volumetric response. Postablation next-generation sequencing showed resolution of preexisting mutations, confirming a complete molecular response. This case highlights the feasibility of combining EUS-nCLE and EUS-RFA in a single session, a minimally invasive approach that may improve outcomes and resource use in high-surgical-risk patients.

Figure.

Figure

Open in a new tab

DISCLOSURE

The following authors disclosed financial relationships: S. G. Krishna: Research grant support: Mauna Kea Technologies and TaeWoong Medical, USA. All other authors disclosed no financial relationships. Research in this publication was supported by The National Institutes of Health (NIH) and National Cancer Institute (NCI) R01 grant R01CA279965 (to The Ohio State University). The content is solely the authors’ responsibility and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

PATIENT CONSENT

Informed consent was obtained from patient for publication.

Contributor Information

Matthew Yoder, Division of Internal Medicine, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, Ohio, USA.

Fadi Hawa, Division of Gastroenterology, Hepatology, and Nutrition, OSUWMC, Columbus, Ohio, USA.

Ahmed Abdelbaki, Division of Gastroenterology, Hepatology, and Nutrition, OSUWMC, Columbus, Ohio, USA.

Jennifer Rath, Department of Radiology, OSUWMC, Columbus, Ohio, USA.

Zarine K. Shah, Department of Radiology, OSUWMC, Columbus, Ohio, USA.

Somashekar G. Krishna, Division of Gastroenterology, Hepatology, and Nutrition, OSUWMC, Columbus, Ohio, USA, The James Comprehensive Cancer Center, OSUWMC, Columbus, Ohio, USA.

Gastrointest Endosc. 2025 Jul 17;103(1):182–184.

Commentary

Tara Keihanian 1, Amy Tyberg 2

In this case, the authors described an interesting case of a single-session integration of EUS-nCLE and EUS-RFA for a pancreatic cyst in a high-risk patient. EUS-nCLE has revolutionized the approach to pancreatic cysts! EUS-nCLE has a high diagnostic accuracy (~97%) for the detection of branch-duct intraductal papillary mucinous neoplasm, evident by flat epithelium and monolayered nuclei. Pancreatic cyst resolution with EUS-RFA has been reported in the literature at varying rates, with up to 85% of cases showing improvement. This minimally invasive technique has acceptable durability with a limited adverse event profile. This case is unique in demonstrating the need for a paradigm shift toward personalized endotherapy by integrating nCLE imaging and therapeutic ablation. This upfront approach is superior to the conventional stepwise workflow by eliminating not only the delay in diagnosis and treatment but also the unnecessary risks associated with anesthesia and procedural adverse events.

RESOURCES