Clin Endosc.  2022 Mar;55(2):270-278. 10.5946/ce.2021.083.

Peroral Pancreatoscopy with Videoscopy and Narrow-Band Imaging in Intraductal Papillary Mucinous Neoplasms with Dilatation of the Main Pancreatic Duct

• Kishimoto Y
• Okano N
• Ito K
• Takuma K
• Hara S
• Iwasaki S
• Yoshimoto K
• Ymada Y
• Watanabe K
• Kimura Y
• Nakagawa H
• Igarashi Y

• KMID: 2527572
• DOI: http://doi.org/10.5946/ce.2021.083

Abstract

Background/Aims
Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs.
Methods
POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up.
Results
A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin.
Conclusions
In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

Keyword

Endoscopic diagnosis; Image-enhanced endoscopy; Intraductal papillary mucinous neoplasm; Peroral video-pancreatoscopy

Figure

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  Fig. 1. Peroral pancreatoscopy images of intraductal papillary mucinous neoplasms. (A, B) White-light imaging and narrow-band imaging of a sessile morpholgy. (C, D) White-light imaging and narrow-band imaging of a semipedunculated morphology.

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  Fig. 2. Peroral pancreatoscopy images of intraductal papillary mucinous neoplasms. (A, B) White-light imaging and narrow-band imaging of a villous morphology. (C, D) White-light imaging and narrow-band imaging of a vegetative morphology.

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  Fig. 3. Study flowchart. IPMN, intraductal papillary mucinous neoplasm; MPD, main pancreatic duct; POPS, peroral pancreatoscopy

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  Fig. 4. Prognosis of sessile morphology (Is): endoscopic morphology and clinical course. Ca, Adenocrcinoma. M, months.

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  Fig. 5. Prognosis of semipedunculated morphology (Isp). M, months.

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  Fig. 6. Prognosis of villous morphology (Vil). M, months.

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  Fig. 7. Prognosis of vegetative morphology (Veg). Ca, Adenocrcinoma; M, months.

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  Fig. 8. Prognosis of sessile morphology (Is) + semipedunculated morphology (Isp) versus villous morphology (Vil) + vegetative morphology (Veg).

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  Fig. 9. Comparison of prognosis between the benign and malignant groups based on endoscopic diagnosis.

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