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Digital pancreatoscopy in the evaluation of main duct intraductal papillary mucinous neoplasm: a multicenter study

Arvind J Trindade1, Petros C Benias1,2, Praneet Kurupathi2

  • 1Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Division of Gastroenterology, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, United States.

Endoscopy
|April 27, 2018
PubMed
Abstract

Insights

Digital pancreatoscopy offers valuable insights for main duct intraductal papillary mucinous neoplasm (MD-IPMN), especially in cases with diffuse pancreatic duct dilation. It can alter surgical decisions, improving diagnostic accuracy.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Diagnostic Imaging

Background:

  • Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms of the pancreas.
  • Main duct IPMN (MD-IPMN) requires accurate diagnosis and management.
  • Digital pancreatoscopy is an emerging endoscopic tool for pancreatic lesion evaluation.

Purpose of the Study:

  • To evaluate the diagnostic and therapeutic impact of digital pancreatoscopy in MD-IPMN.
  • To assess the safety and incremental yield of digital pancreatoscopy.
  • To determine if pancreatoscopy influences surgical planning for MD-IPMN.

Main Methods:

  • Multicenter retrospective study including 31 patients with MD-IPMN.
  • Analysis of safety, pathology yield compared to cross-sectional imaging and EUS.
  • Assessment of pancreatoscopy's role in dictating surgical procedures.

Main Results:

  • Digital pancreatoscopy revealed findings missed by prior imaging in 42% of cases.
  • Pancreatoscopy dictated surgical approach in 42% of patients.
  • In diffusely dilated ducts (>10mm), pancreatoscopy guided surgery in 77% of cases, versus 17% in focally dilated ducts (P=0.001).

Conclusions:

  • Digital pancreatoscopy provides significant incremental diagnostic yield in MD-IPMN.
  • It is particularly valuable in MD-IPMN with diffusely dilated pancreatic ducts.
  • Consider digital pancreatoscopy in the diagnostic algorithm for MD-IPMN, especially when focal lesions are absent on initial imaging.

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