Commentary

This video by Hirano and co-workers [11] shows an interesting case of pancreatoscopy performed with an ultrathin endoscope (5 mm diameter) with a transparent hood attached to the tip; the endoscope was inserted through a gastric fistula secondary to neoplastic degeneration of a branch duct intraductal papillary mucinous neoplasm (BD-IPMN). The video is well documented and the quality of the images is good; the authors propose a “romantic” description of the endoscopic findings comparing the malignant evolution of the IPMN to an underwater world.

Magnetic resonance cholangiopancreatography (MRCP) had clearly shown a degeneration of the BD-IPMN. If pancreatoscopy changed the therapeutic workup for this gentleman in his 80s, the indication is shareable; otherwise it seems questionable, bearing in mind also the risk of complications. Biopsy to confirm malignancy could easily have been performed with a standard gastroscope through the gastric fistula, as visible in Fig. 2 of the accompanying description. More data regarding patient follow-up are needed (surgery, chemotherapy, or “best supportive care”?). Pancreatoscopy is a fascinating technique but its indications need to be defined.

Publication History

Article published online:
30 October 2024

• References

• 1 Hirano K, Maehara K, Hattori D. et al. Into the pancreas: an underwater world filled with an intraductal papillary mucinous neoplasm seen via peroral pancreatoscopy. Endoscopy 2024; 56: E560-E562 DOI: 10.1055/a-2339-2121.