Cost-Benefit Analysis and Resource Implications of Endoscopic Ultrasound-Guided Confocal Endomicroscopy in Pancreatic Cysts

Anjuli Luthra, Phil A. Hart, Georgios I. Papachristou, Kyle Porter, Mary E. Dillhoff, Andrei Manilchuk, Jordan M. Cloyd, Timothy M. Pawlik, Allan Tsung, Darwin L. Conwell, Somashekar G. Krishna

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background and Aims: EUS-guided needle-based confocal laser endomicroscopy (nCLE) improves the diagnostic accuracy of pancreatic cystic lesions (PCLs) but concerns regarding its expense have limited widespread adoption of this technology. We conducted a cost-benefit analysis to assess the healthcare resource implications of adding EUS-nCLE to the standard of care (SOC) management of PCLs. Methods: A post-hoc analysis of a prospective study (2015-2018) evaluating EUS-nCLE for the diagnosis of PCLs was performed. The SOC diagnosis was based on clinical history, PCL morphology, and cyst fluid analysis. A minimum of 5-years surveillance was included, the cost of EUS and MRI/MRCP was derived from institutional billing data (US$), and the total hospital costs (adjusted for inflation) for pancreatic operations were derived from the National (US) Readmission Database. Results: A reference diagnosis was available in 93 subjects (mean cyst size = 36.4 ± 15.7 mm; surgical histopathology, n = 67 and diagnostic molecular markers in cyst fluid, n = 26). SOC and nCLE were discordant in 13 (14%) subjects. The addition of nCLE led to 11 subjects being clinically down-staged from mucinous to non-mucinous not warranting surgery (total cost savings = $1,080,418), 1 subject upstaged from non-mucinous to mucinous, warranting surgical resection (cost savings of 5-years surveillance: $46,200), and 1 subject incorrectly classified as non-mucinous (cost excess of 5-years surveillance: $46,200). Overall, the addition of nCLE led to a net savings of $ 442,438 (mean: $ 4757.40/patient) for this cohort. Conclusion: EUS-nCLE is potentially cost-beneficial in the management of PCLs (≥3 cm) by preventing at least one unnecessary pancreatic surgery for every 10 subjects undergoing evaluation by current practices. number: NCT02516488.

Original languageEnglish
Pages (from-to)35-44
Number of pages10
JournalTechniques and Innovations in Gastrointestinal Endoscopy
Issue number1
StatePublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.


  • Confocal endomicroscopy
  • Cost-benefit analysis
  • Endoscopic ultrasound
  • Pancreatic cancer
  • Pancreatic cyst
  • Pancreatic surgery

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging


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