Efficacy, Safety, and Outcomes of Endoscopic Retrograde Cholangiopancreatography With Per-Oral Pancreatoscopy

Parbhu, Sheeva K.; Siddiqui, Ali A.; Murphy, Megan; Noor, Arish; Taylor, Linda J.; Mills, Alyssa; Adler, Douglas G.

doi:10.1097/mcg.0000000000000796

Cited by 21 publications

(23 citation statements)

References 23 publications

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“…Overall the advancement of the scope in the pancreatic duct as well as performing biopsies can be more complicated than in the bile duct. Dilatation of the stricture can help to obtain biopsies as reported in a case series of 5 patients with indeterminate pancreatic duct stenosis [49]. After dilation, the authors were able to obtain biopsies under direct visualization in 4 of the 5 patients (80%), biopsies were benign in all the cases.…”

Section: Diagnostic Applications Of Pancreatoscopy Pancreatic Stricturesmentioning

confidence: 78%

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Pereira

Costa-Moreira

Macedo

2020

JGLD

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Besides the adverse effects associated with endoscopic retrograde cholangiopancreatography (ERCP), indirect visualization of the biliopancreatic system through fluoroscopy has limited its diagnostic and therapeutic efficacy. Direct visualization through cholangiopancreatoscopy may overcome this limitation and allow the resolution of many dilemmas related to the diagnostic and therapeutic drawbacks of ERCP. Herein, we discuss the current indications of single-operator cholangioscopy (SOC) concerning the diagnostic interventions within the biliopancreatic system. The current role of SOC in the diagnosis of pancreatobiliary stenosis, primary sclerosing cholangitis, intraductal papillary mucinous neoplasm, and pre-surgical mapping of neoplastic lesions were reviewed. There is growing data in the literature supporting the early implementation of SOC in the diagnostic algorithm of pancreatobiliary diseases. In selected cases, this could prevent diagnostic delay and reduce the risks and costs related to repeated ERCPs. This potential characterizes SOC as safety and cost-effective.

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Section: Diagnostic Applications Of Pancreatoscopy Pancreatic Stricturesmentioning

confidence: 78%

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Pereira

Costa-Moreira

Macedo

2020

JGLD

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“…Most studies included patients who had failed conventional ERCP techniques[12,21,22] or ERCP with ESWL[9,14,19,23]. Median reported PD stone size ranged from 5 mm[22]-15 mm[9]. Some studies[9,19] reported 23 h observation after index POP procedure or pancreatic sphincterotomy.…”

Section: Resultsmentioning

confidence: 99%

“…Parbhu et al[22] reported a 50% success rate in 20 patients using only balloon or basket sweeps due to better visualization with POP. Complete clearance in a single procedure was reported in 100% patients by Maydeo et al[21] and 61% by Attwell et al[9].…”

Section: Resultsmentioning

confidence: 99%

“…Parbhu et al[22] studied the impact of POP in 16 patients who had EUS suggestive of IPMN, but definitive diagnosis could not be achieved. They achieved 100% success in obtaining biopsies with a diagnostic accuracy of 75%.…”

Section: Discussionmentioning

confidence: 99%

“…Parbhu et al[22] were successful in dilating 100% strictures in five patients in their study, and were able to obtain targeted biopsies in 80%. Dorsal ductal pancreatoscopy (DDP) via minor papilla can be considered in patients with true or pseudo-divisum presenting with indeterminate strictures, which may be inaccessible via major papilla.…”

Section: Discussionmentioning

confidence: 99%

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Role of pancreatoscopy in management of pancreatic disease: A systematic review

Kaura

Willingham

Chawla

2019

WJGE

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BACKGROUNDPer-oral pancreatoscopy (POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIMTo evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODSTo determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid. Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound (IDUS) and POP combined with image-enhancing technology.RESULTSThe success rate for complete ductal stone clearance ranged from 37.5%-100%. Factors associated with failure included the presence of strictures, multiple stones and the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy, and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSIONCurrent evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.

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Advanced Intraductal Pancreatic Imaging

McIntyre¹,

Adler²

2021

Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Efficacy, Safety, and Outcomes of Endoscopic Retrograde Cholangiopancreatography With Per-Oral Pancreatoscopy

Cited by 21 publications

References 23 publications

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Cholangiopancreatoscopy: Expanding the Diagnostic Indications of Endoscopic Retrograde Cholangiopancreatography

Role of pancreatoscopy in management of pancreatic disease: A systematic review

Advanced Intraductal Pancreatic Imaging

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