Download PDF
CC BY 4.0 · Endoscopy 2023; 55(01): 25-35
DOI: 10.1055/a-1869-0180
Systematic review

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

David M. de Jong  ‡   *
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Pauline M. C. Stassen‡   *
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Bas Groot Koerkamp
2   Department of Surgery, Erasmus MC Cancer Institute, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Mark Ellrichmann
3   Department of Interdisciplinary Endoscopy, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Petko I. Karagyozov
4   Department of Interventional Gastroenterology, Acibadem City Clinic Tokuda University Hospital, Sofia, Bulgaria
,
Andrea Anderloni
5   Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
,
Leena Kylänpää
6   Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
George J. M. Webster
7   Department of Gastroenterology, University College London Hospitals, London, UK
8   Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
,
Lydi M. J. W. van Driel
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Marco J. Bruno
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Pieter J. F. de Jonge
1   Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
,
on behalf of the European Cholangioscopy study group › Author Affiliations
› Further Information
Also available at
   Permissions and Reprints


Abstract

Background Confirming the diagnosis, invasiveness, and disease extent of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is challenging. The aim of this study was 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 25 articles were identified and included in this review; with 22 of these reporting on the diagnostic yield of POP in IPMN and 11 reporting on the effect of pre- or intraoperative POP on clinical decision-making. Cannulation and 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-endoscopic retrograde cholangiopancreatography pancreatitis, with a pooled rate of 10 %, mostly of mild severity. Regarding the impact of POP on clinical decision-making, POP findings altered the surgical approach in 13 %–62 % of patients.

Conclusion POP is technically successful in the vast majority of patients with (suspected) IPMN, has a consistently high diagnostic accuracy, but an adverse event rate of 12 %. Data on intraoperative pancreatoscopy are 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.

* Shared first authorship


Supplementary material



Publication History

Received: 06 December 2021

Accepted after revision: 23 May 2022

Accepted Manuscript online:
03 June 2022

Article published online:
20 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Cooper CL, O'Toole SA, Kench JG. Classification, morphology and molecular pathology of premalignant lesions of the pancreas. Pathology 2013; 45: 286-304
    CrossrefPubMedGoogle Scholar
  • 2 Lafemina J, Katabi N, Klimstra D. et al. Malignant progression in IPMN: A cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol 2013; 20: 440-447
    CrossrefPubMedGoogle Scholar
  • 3 Tanaka M, Fernandez-del Castillo C, Adsay V. et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-197
    CrossrefPubMedGoogle Scholar
  • 4 Tanaka M, Fernández-Del Castillo C, Kamisawa T. et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017; 17: 738-753
    CrossrefPubMedGoogle Scholar
  • 5 He J, Cameron JL, Ahuja N. et al. Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?. J Am Coll Surg 2013; 216: 657-665 ; discussion 665-657
    CrossrefPubMedGoogle Scholar
  • 6 Sauvanet A, Couvelard A, Belghiti J. Role of frozen section assessment for intraductal papillary and mucinous tumor of the pancreas. World J Gastrointest Surg 2010; 2: 352-358
    CrossrefPubMedGoogle Scholar
  • 7 Sato S, Miyazawa K, Shiobara M. et al. [Intraoperative Pancreatoscopy to Assess the Resection Margin in Intraductal Papillary Mucinous Neoplasm-A Case Report]. Gan To Kagaku Ryoho 2019; 46: 2521-2523
    PubMedGoogle Scholar
  • 8 Fujita N, Lee S, Kobayashi G. et al. Pancreatoscopy for mucus producing pancreatic tumor. Dig Endosc 1990; 2: 110-115
    CrossrefPubMedGoogle Scholar
  • 9 Ozkan H, Saisho H, Yamaguchi T. et al. Clinical usefulness of a new miniscope in the diagnosis of pancreatic disease. Gastrointest Endosc 1995; 42: 480-485
    CrossrefPubMedGoogle Scholar
  • 10 Kaneko T, Nakao A, Nomoto S. et al. Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 1998; 133: 263-267
    CrossrefPubMedGoogle Scholar
  • 11 Mukai H, Yasuda K, Nakajima M. Differential diagnosis of mucin-producing tumors of the pancreas by intraductal ultrasonography and peroral pancreatoscopy. Endoscopy 1998; 30 (Suppl. 01) A99-A102
    PubMedGoogle Scholar
  • 12 Yamaguchi T, Hara T, Tsuyuguchi T. et al. Peroral pancreatoscopy in the diagnosis of mucin-producing tumors of the pancreas. Gastrointest Endosc 2000; 52: 67-73
    CrossrefPubMedGoogle Scholar
  • 13 Atia GN, Brown RD, Alrashid A. et al. The role of pancreatoscopy in the preoperative evaluation of intraductal papillary mucinous tumor of the pancreas. J Clin Gastroenterol 2002; 35: 175-179
    CrossrefPubMedGoogle Scholar
  • 14 Hara T, Yamaguchi T, Ishihara T. et al. Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002; 122: 34-43
    Google Scholar
  • 15 Yamao K, Ohashi K, Nakamura T. et al. Efficacy of peroral pancreatoscopy in the diagnosis of pancreatic diseases. Gastrointest Endosc 2003; 57: 205-209
    CrossrefPubMedGoogle Scholar
  • 16 Yasuda K, Sakata M, Ueda M. et al. The use of pancreatoscopy in the diagnosis of intraductal papillary mucinous tumor lesions of the pancreas. Clin Gastroenterol Hepatol 2005; 3 Suppl: S53-S57
    CrossrefPubMedGoogle Scholar
  • 17 Itoh A, Hirooka Y, Kawashima H. et al. Endoscopic approach to the pancreatobiliary tract using narrow band imaging. Dig Endosc 2007; 19: S115-S120
    CrossrefPubMedGoogle Scholar
  • 18 Itoi T, Sofuni A, Itokawa F. et al. Initial experience of peroral pancreatoscopy combined with narrow-band imaging in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas (with videos). Gastrointest Endosc 2007; 66: 793-797
    Google Scholar
  • 19 Miura T, Igarashi Y, Okano N. et al. Endoscopic diagnosis of intraductal papillary-mucinous neoplasm of the pancreas by means of peroral pancreatoscopy using a small-diameter videoscope and narrow-band imaging. Dig Endosc 2010; 22: 119-123
    CrossrefPubMedGoogle Scholar
  • 20 Brauer BC, Chen YK, Ringold DA. et al. Peroral pancreatoscopy via the minor papilla for diagnosis and therapy of pancreatic diseases. Gastrointest Endosc 2013; 78: 545-549
    CrossrefPubMedGoogle Scholar
  • 21 Arnelo U, Siiki A, Swahn F. et al. Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN). Pancreatology 2014; 14: 510-514
    Google Scholar
  • 22 Nagayoshi Y, Aso T, Ohtsuka T. et al. Peroral pancreatoscopy using the SpyGlass system for the assessment of intraductal papillary mucinous neoplasm of the pancreas. J Hepato-Biliary-Pancreatic Sci 2014; 21: 410-417
    CrossrefPubMedGoogle Scholar
  • 23 Pucci MJ, Johnson CM, Punja VP. et al. Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons?. J Gastrointest Surg 2014; 18: 1100-1107
    CrossrefPubMedGoogle Scholar
  • 24 Navez J, Hubert C, Gigot JF. et al. Impact of intraoperative pancreatoscopy with intraductal biopsies on surgical management of intraductal papillary mucinous neoplasm of the pancreas. J Am Coll Surg 2015; 221: 982-987
    CrossrefPubMedGoogle Scholar
  • 25 Kurihara T, Yasuda I, Isayama H. et al. Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases: Prospective multicenter study in Japan. World J Gastroenterol 2016; 22: 1891-1901
    CrossrefPubMedGoogle Scholar
  • 26 El Hajj II, Brauer BC, Wani S. et al. Role of per-oral pancreatoscopy in the evaluation of suspected pancreatic duct neoplasia: a 13-year U.S. single-center experience. Gastrointest Endosc 2017; 85: 737-745
    CrossrefPubMedGoogle Scholar
  • 27 Parbhu SK, Siddiqui AA, Murphy M. et al. Efficacy, safety, and outcomes of endoscopic retrograde cholangiopancreatography with per-oral pancreatoscopy: a multicenter experience. J Clin Gastroenterol 2017; 51: e101-e105
    CrossrefPubMedGoogle Scholar
  • 28 Ohtsuka T, Gotoh Y, Nakashima Y. et al. Role of SpyGlass-DStm in the preoperative assessment of pancreatic intraductal papillary mucinous neoplasm involving the main pancreatic duct. Pancreatology 2018; 18: 566-571
    CrossrefPubMedGoogle Scholar
  • 29 Trindade AJ, Benias PC, Kurupathi P. et al. Digital pancreatoscopy in the evaluation of main duct intraductal papillary mucinous neoplasm: A multicenter study. Endoscopy 2018; 50: 1095-1098
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Han S, Raijman I, Machicado JD. et al. Per oral pancreatoscopy identification of main-duct intraductal papillary mucinous neoplasms and concomitant pancreatic duct stones: not mutually exclusive. Pancreas 2019; 48: 792-794
    CrossrefPubMedGoogle Scholar
  • 31 Tyberg A, Raijman I, Siddiqui A. et al. Digital pancreaticocholangioscopy for mapping of pancreaticobiliary neoplasia: can we alter the surgical resection margin?. J Clin Gastroenterol 2019; 53: 71-75
    CrossrefPubMedGoogle Scholar
  • 32 Yamaguchi T, Shirai Y, Ishihara T. et al. Pancreatic juice cytology in the diagnosis of intraductal papillary mucinous neoplasm of the pancreas: Significance of sampling by peroral pancreatoscopy. Cancer 2005; 104: 2830-2836
    CrossrefPubMedGoogle Scholar
  • 33 Kaura T, Willingham FF, Chawla S. Role of pancreatoscopy in management of pancreatic disease: A systematic review. World J Gastrointest Endosc 2019; 11: 155-167
    CrossrefPubMedGoogle Scholar
  • 34 Sethi A, Tyberg A, Slivka A. et al. Digital single-operator cholangioscopy (DSOC) improves interobserver agreement (IOA) and accuracy for evaluation of indeterminate biliary strictures: The Monaco classification. J Clin Gastroenterol 2022; 56: e94-e97
    CrossrefPubMedGoogle Scholar
  • 35 Kahaleh M, Turner BG, Bezak K. et al. Probe-based confocal laser endomicroscopy in the pancreatic duct provides direct visualization of ductal structures and aids in clinical management. Dig Liver Dis 2015; 47: 202-204
    CrossrefPubMedGoogle Scholar
  • 36 Löhr JM, Lönnebro R, Stigliano S. et al. Outcome of probe-based confocal laser endomicroscopy (pCLE) during endoscopic retrograde cholangiopancreatography: A single-center prospective study in 45 patients. United European Gastroenterol J 2015; 3: 551-560
    CrossrefPubMedGoogle Scholar
  • 37 Yelamali A, Mansard MJ, Dama R. et al. Intraoperative pancreatoscopy with narrow band imaging: a novel method for assessment of resection margins in case of intraductal papillary mucinous neoplasm. Surg Endosc 2012; 26: 3682-3685
    CrossrefPubMedGoogle Scholar
  • 38 Thornton GD, McPhail MJ, Nayagam S. et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: a meta-analysis. Pancreatology 2013; 13: 48-57
    CrossrefPubMedGoogle Scholar
  • 39 Stassen PMC, de Jonge PJF, Webster GJM. et al. Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey. Endosc Int Open 2021; 9: E1704-E1711
    Article in Thieme ConnectPubMedGoogle Scholar