Using endoscopic ultrasound-guided needle-based confocal laser endomicroscopy improves diagnostic accuracy for pancreatic cystic lesions, reducing unnecessary surgeries.

• Overall diagnostic accuracy improved from 73% to 85% with EUS-NCLE.
• Misclassification of lesions dropped, reducing unnecessary benign resections from 7.2 to 4.1 per observer.

Combine EUS-NCLE with standard evaluation for better outcomes, especially for larger cysts.

• Mucinous versus non-mucinous classification accuracy rose from 90% to 96%.