The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis

Abstract

Introduction: Confirming the diagnosis, invasiveness, and extent of disease of intraductal papillary mucinous neoplasms (IPMN) of the pancreas is challenging. The aim of this study is to summarize the literature on the efficacy and safety of peroral pancreatoscopy (POP) in the diagnosis of IPMN, including the impact of pre- and intraoperative POP on the management of IPMN. Methods: The EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL and Google Scholar databases were systematically searched for articles. Eligible articles investigated cohorts of patients who underwent POP for (suspected) IPMN. Results: Twenty-five articles were identified and included in this review. Twenty-two articles reported on the diagnostic yield of POP in IPMN and eleven articles reported on the effect of pre- or intraoperative POP on clinical decision making. Cannulation, observation rates and overall diagnostic accuracy were high across all studies. Frequently reported visual characteristics of IPMN were intraductal fish-egg-like lesions, hypervascularity, and granular mucosa. Overall, the adverse event rate was 12%, primarily consisting of post-ERCP pancreatitis with a pooled rate of 10%, most of mild severity. Regarding the impact of POP on clinical decision making, in 13-62% of patients POP findings altered the surgical approach. Conclusion: POP is technically successful in the vast majority of patients with (suspected) IPMN, has a considerably high diagnostic accuracy, but an adverse event rate of 12%. Data on intraoperative pancreatoscopy is scarce, but small studies suggest its use can alter surgical management. Future studies are needed to better define the role of POP in the diagnostic work-up of IPMN.

Recent advances in detecting premalignant pancreatic cysts

“…It involves passing a nCLE through a 19 G needle, which enables real-time microscopic visualisation of tissue. Pooled data produced a sensitivity of 82.4%, a specificity of 96.6%, and a diagnostic accuracy of 88.6% in diagnosing pancreatic cyst subtypes% [63] . The adverse events reported were mild bleeding, infection, and mild pancreatitis (1.4%-7%).…”

Inspection of intraductal papillary mucinous neoplasm via the papilla using a novel slim pancreatoscope under balloon enteroscopy

“…Peroral pancreatoscopy (POPS) is useful for the direct visualization of intraductal lesions in the pancreatic duct 1 2 3 . However, POPS in patients with Roux-en-Y anastomosis via the papilla under balloon enteroscopy is difficult because pancreatoscopes are approximately 10 Fr in diameter and cannot pass through the forceps channel of the balloon enteroscope.…”

Usefulness of texture and color enhancement imaging in peroral pancreatoscopy

“…We report a case of pancreatic duct dilation with suspected main duct type intraductal papillary mucinous neoplasm (IPMN) in a patient who had undergone peroral pancreatoscopy (POPS) 1,2 using texture and color enhancement imaging (TXI) equipped in a new‐generation image‐enhanced endoscopy (IEE) system (EVIS X1; Olympus Marketing, Japan) 3 …”