Clinical Experience with Prototype Pancreatoscopes

Abstract

Peroral pancreatoscopy (PPS) was introduced at our institute in 1982, with the aim of improving diagnostic accuracy in patients with pancveatic diseases, and as a preliminary, procedure for therapeutic interventions to the pancreas. However, limitations in instrumentation permitted us to observe only the main pancreatic duct. This is a report of our experience with 2 types of peroral Pancreatoscopes and our findings in patients with chronic pancreatitis and pancreatic cancer. We subjected 30 patients suspected to have pancreatic diseuse to PPS, using either the CPF‐29X, which has an external diameter of 2.9 mm (Olympus: Japan), or the PA‐08, which has an external diameter of 0.8 mm (a modification of the angioscope, Fujinon: Japan). PPS with the CPF‐29h was attempted in 18 cases (pancreatic cancer, 11; chronic pancreatitis, 7), and was successfully introduced into the main pancreatic duct in I 6 cases. This allowed good visualization of the main pancreatic duct and a more definitive diagnosis in 11 cases. On the other hand, PPS with the PA‐08 was successfully introduced in all 12 of the cases in which it was attempted (pancreatic cancer, 7; chronic pancreatitis, 5) and permitted satisfactory endoscopic observation and accurate diagnosis in 9 cases. Puncreatic cancer appeared as an irregular elevation of the pancveatic duct mucosa, while chronic pancreatitis presented as a smooth stenosis, without significant mucosal changes. Thus, PPS is a valuable alternative or supplementary procedure to present‐day diagnostic imaging methods of arriving at a more definitive diagnosis in difficult cases. For the biopsy of lesions under direct vision and the possibility of therapeutic interventions to the pancreas, however, we propose the development of a pancreatoscope equipped with a forceps channel and which has an external diameter of less than 1 mm.