Interest of pancreatoscopy in the endoscopic management of chronic pancreatitis: results of a prospective study

Aims In chronic pancreatitis (CP), stones and strictures of the main pancreatic duct (MPD) can cause chronic abdominal pain and recurrent acute pancreatitis. In some cases, endoscopic treatment may be indicated with uncertain efficacy due to the high risk of recurrence. This risk is correlated with residual calculi and stenosis in the CP. The aim of this study was to compare the performance of pancreatoscopy versus pancreatography in diagnosing residual calculi and strictures in the MPD at the end of endoscopic treatment.

Methods In this prospective, single-centre study, 27 patients requiring endoscopic treatment of their symptomatic chronic pancreatitis were included from July 2021 to February 2023 . The primary endpoint was the absence or presence of calculi and/or MPD stenosis. On definitive removal of the pancreatic prosthesis, pancreatography and pancreatoscopy were performed at the same endoscopy. Patients were followed up for 2 years to assess the clinical efficacy of the endoscopic treatment.

Results 23 patients had CP of alcoholic origin and 4 of undetermined origin. All patients had stones and stenosis of the MPD, responsible for chronic abdominal pain. 2 patients were lost to follow-up. The mean age was 60.07 (28-82) years. Symptomatic stones or strictures were located in the head (65%), body (35%) and tail (10%). The lenght of endoscopic treatment was 16.8 (10-24) months and the number of ERCPs per patient was 3.4 (1-8). Endoscopic treatment was effective in 80% of patients. Complete pancreatoscopy was not possible in 3 patients because of stenosis of the MPD that could not be crossed after dilatation. Pancreatoscopy revealed residual calculi, not visualised by pancreatography, in 13 patients (48%). All the stones were removed using spybasket (3 patients after a 2nd pancreatoscopy). Pancreatoscopy was used to modify the therapeutic management of 15 patients (55%): 2 for the treatment of residual MPD stenosis by dilatation and insertion of new pancreatic stents and 13 for the treatment of residual pancreatic calculi. Pancreatoscopy did not appear to add any morbidity.

Conclusions Pancreatoscopy may be of interest at the end of endoscopic treatment of chronic pancreatitis, as it is more effective than pancreatography in diagnosing residual pancreatic calculi in the MPD.

Publication History

Article published online:
15 April 2024