Feasibility Study Using a New Small Electronic Pancreatoscope: Description of Findings in Chronic Pancreatitis

Background and Study Aims: Numerous images characteristic of chronic pancreatitis have been obtained with fiberoptic peroral pancreatoscopy systems. However, the resolution of these images is inferior to that obtained with peroral electronic pancreatoscopy (PEPS). Clearer images of the pancreatic duct with chronic pancreatitis have now been documented, in some cases using PEPS alone. The significance of this finding is reported here.
Patients and Methods: A total of 42 PEPS procedures were carried out in 36 patients with chronic pancreatitis, without sphincterotomy or balloon dilation of the papilla of Vater. Using endoscopic retrograde pancreatography, the patients were classified as having equivocal (n = 5), mild (n = 5), moderate (n = 15), or marked (n = 11) degrees of chronic pancreatitis. The insertion rate with PEPS was 90 % (38 of 42 procedures), and it was ultimately possible to examine five, three, 13, and 11 patients in each group, respectively.
Results: Images of turbid pancreatic juice, protein plugs of various shapes, pancreatic calculi, indistinct vascular markings, whitish mucosa, local redness, scattered redness, disappearance of the fold, deformation of the fold, irregularly dilated lumen, and stenosis were found to be characteristic of chronic pancreatitis. These images were obtained using PEPS.
Conclusions: PEPS proved to be a feasible new technique for diagnosing chronic pancreatitis, and it was able to detect abnormal findings more clearly than other imaging methods.

References

• 1 Tajiri H, Kobayashi M, Ohtsu A. et al . Peroral pancreatoscopy for the diagnosis of pancreatic diseases.  Pancreas. 1998;  16 408-412
• 2 Jung M, Zipf A, Schoonbroodt D. et al . Is pancreatoscopy of any benefit in clarifying the diagnosis of pancreatic duct lesions.  Endoscopy. 1998;  30 273-280
• 3 Sarner M, Cotton P B. Classification of pancreatitis.  Gut. 1984;  25 756-759
• 4 Kodama T, Sato H, Horii Y. et al . Pancreatoscopy for the next generation: development of the peroral electronic pancreatoscope system.  Gastrointest Endosc. 1999;  49 366-371
• 5 Kodama T, Koshitani T, Sato H. et al . Electronic pancreatoscopy for the diagnosis of pancreatic disease.  Am J Gastroenterol. 2002;  97 617-622
• 6 Tajiri H, Kobayashi M, Niwa H, Furui S. Clinical application of an ultra-thin pancreatoscope using a sequential video converter.  Gastrointest Endosc. 1993;  39 371-374
• 7 Sahel J, Sarles H. Modifications of pure pancreatic juice induced by chronic alcohol consumption.  Dig Dis Sci. 1979;  24 897-905
• 8 de Caro A, Lohse J, Sarles H. Characterization of a protein isolated from pancreatic calculi of men suffering from chronic calcifying pancreatitis.  Biochem Biophys Res Commun. 1979;  87 1176-1182
• 9 Gross J, Brauer A W, Bringhurst R F. et al . An unusual bovine pancreatic protein exhibiting pH-dependent globule-fibril transformation and unique amino acid sequence.  Proc Natl Acad Sci USA. 1985;  82 5627-5631
• 10 Harada H, Miyake H, Miki H. et al . Role of endoscopic elimination of protein lugs in the treatment of chronic pancreatitis.  Gastroenterol Jpn. 1982;  17 463-468
• 11 Tympner F, Rösch W. The treatment of chronic recurrent pancreatitis with depot secretin: a preliminary report.  Hepatogastroenterology. 1986;  33 159-162
• 12 Braganza J M, Hunt L P, Warwick F. Relationship between pancreatic exocrine function and ductal morphology in chronic pancreatitis.  Gastroenterology. 1982;  82 1341-1347
• 13 Bozkurt T, Braun U, Leferink S. et al . Comparison of pancreatic morphology and exocrine functional impairment in patients with chronic pancreatitis.  Gut. 1994;  35 1132-1136
• 14 Lankisch P G, Seidensticker F, Otto J. et al . Secretin-pancreozymin test and endoscopic cholangiopancreatography: both are necessary for diagnosing or excluding chronic pancreatitis.  Pancreas. 1996;  12 149-152
• 15 Walsh T N, Rode J, Theis B A, Russell R C. Minimal change chronic pancreatitis.  Gut. 1992;  33 1566-1571