Subscribe to RSS
DOI: 10.1055/a-2384-8349
Into the pancreas: an underwater world filled with an intraductal papillary mucinous neoplasm seen via peroral pancreatoscopy
Although peroral pancreatoscopy (POPS) has been developed for detailed visualization of intraductal lesions, the images obtained are often inadequate because of the difficulty of insertion, the proximity of the pancreatoscope to the lesion, or visualization challenges due to mucus. Performance can be improved when it is combined with intraductal ultrasonography (IDUS) [1], narrow-band imaging (NBI) [2], and probe-based confocal laser endomicroscopy (pCLE) [3]; however, POPS alone has not achieved high quality intraductal imaging and is still under development.
Here, we report for the first time the use of an ultrathin endoscope with a transparent hood at the tip (Nichendo; Fujifilm Co., Tokyo, Japan) in POPS. This technique has been used in endoscopic submucosal dissection [4]; however, its use in the pancreaticobiliary region has not been reported.
A man in his 80s underwent follow-up magnetic resonance cholangiopancreatography (MRCP) for a branch duct intraductal papillary mucinous neoplasm (BD-IPMN); a fistula between the pancreatic duct branch and the stomach was suspected, with gastric perforation of the BD-IPMN ([Fig. 1]). To obtain a definitive diagnosis, we initially attempted visualization with a conventional endoscope (GIF-H290Z; Olympus, Tokyo, Japan); however, insertion was difficult ([Fig. 2]). Therefore, an ultrathin endoscope (GIF-XP260N; Olympus) with a transparent hood was used ([Fig. 3], [Video 1]).
Quality:
This method enabled visualization of the pancreatic duct and its branches. White-light endoscopy (WLE) and NBI allowed visualization of the mucosa with high quality images and suggested a relationship between the mucosal appearance and atypical tissue ([Fig. 4]). Characteristic findings including a “bleached coral-like appearance”, indicating rough mucosa, “jellyfish-like appearance” at the entrance of the pancreatic branch duct, and “anemone-like appearance” near the gastrostomy were seen ([Fig. 5]).
This is the first report of an ultrathin endoscope with a transparent hood being used for POPS, providing high quality intraductal pancreatic images, improved insertion, and a stable field of view.
Endoscopy_UCTN_Code_CCL_1AZ_2AB
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
Endoscopy 2024; 56: E560–E562. doi: 10.1055/a-2339-2121
#
Conflict of Interest
The authors declare that they have no conflict of interest.
Acknowledgement
We would like to thank Dr. Goro Watanabe (Hepatobiliary-pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital) for his support and help in editing this paper. We also thank Dr. Mako Koseki (Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel) for providing the audio for the video footage. This work was supported in part by Okinaka Memorial Institute for Medical Research.
-
References
- 1 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
- 2 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: 793-794
- 3 Tanisaka Y, Ryozawa S, Nonaka K. et al. In vivo diagnosis of intraductal papillary mucinous neoplasm with per-oral pancreatoscopy-guided confocal laser endomicroscopy. VideoGIE 2018; 3: 339-340
- 4 Koseki M, Kikuchi D, Odagiri H. et al. Possibility of ultrathin endoscopy in radial incision and cutting for esophageal strictures. VideoGIE 2022; 7: 358-360
Correspondence
Publication History
Article published online:
30 October 2024
© 2024. The Author(s). This article was originally published by Thieme in Endoscopy 2024; 56: E560–E562 as an open access article 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 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
- 2 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: 793-794
- 3 Tanisaka Y, Ryozawa S, Nonaka K. et al. In vivo diagnosis of intraductal papillary mucinous neoplasm with per-oral pancreatoscopy-guided confocal laser endomicroscopy. VideoGIE 2018; 3: 339-340
- 4 Koseki M, Kikuchi D, Odagiri H. et al. Possibility of ultrathin endoscopy in radial incision and cutting for esophageal strictures. VideoGIE 2022; 7: 358-360