Pancreatoscopy-assisted balloon dilation under direct vision in a porcine model

Chronic pancreatitis is an inflammatory condition characterized by irreversible morphological changes in the pancreas, which invariably leads to pancreatic duct (PD) strictures [1]. Currently, PD strictures are typically managed with wire-guided balloon or bougie dilation under X-ray guidance [2] [3]. However, these methods carry a risk of PD perforation.

This study introduces a novel approach involving pancreatoscopy-assisted balloon dilation under direct visualization in a porcine model. First, PD intubation was performed, and a cholangioscope (8 F; eyeMAX; Micro-Tech, Nanjing, China) was advanced into the PD in the porcine model ([Fig. 1], [Fig. 2]). A novel balloon, designed to pass through the working channel of the cholangioscope, was then inserted into the PD ([Fig. 3], [Fig. 4]). Subsequently, balloon dilation was conducted under direct visualization ([Fig. 5], [Video 1]). Finally, the balloon was deflated and withdrawn from the PD. No serious adverse events were observed during the 1-week follow-up period.

Fig. 1 Pancreatic duct intubation was conducted in a porcine model.

Fig. 2 The cholangioscope (8 F; eyeMAX; Micro-Tech, Nanjing, China) was inserted into the pancreatic duct.

Fig. 3 The novel balloon can pass through the working channel of the cholangioscope.

Fig. 4 The novel balloon was inserted into the pancreatic duct.

Fig. 5 Balloon dilation was performed under direct visualization.

Pancreatoscopy-assisted balloon dilation was performed in a porcine model.Video 1

The primary advantage of this technique over traditional wire-guided balloon or bougie dilation under X-ray is that it allows the endoscopist to observe the degree of dilation in a timely manner. Theoretically, this technique could also be applied to the biliary duct or cystic duct. Notably, our team has been exploring cholangioscopy-assisted extraction of gallstones [4]. For patients with a narrow cystic duct, this approach can often achieve optimal results. We propose the term cholangiopancreatoscopy-assisted balloon dilation (CABD) for this technique.

This study preliminary demonstrates the feasibility of pancreatoscopy-assisted balloon dilation in a porcine model. Future applications of this technique may offer significant benefits for patients with biliary duct or PD strictures.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Drewes AM, Bouwense SAW, Campbell CM. et al. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17: 720-731
• 2 Freeman ML, Cass OW, Dailey J. Dilation of high-grade pancreatic and biliary ductal strictures with small-caliber angioplasty balloons. Gastrointest Endosc 2001; 54: 89-92
• 3 Nabi Z, Lakhtakia S. Endoscopic management of chronic pancreatitis. Dig Endosc 2021; 33: 1059-1072
• 4 Zhang W, Chai N, Zhai Y. et al. Cholangioscopy-assisted extraction of choledocholithiasis and partial sediment-like gallstones through papillary support: a pilot exploration for super minimally invasive surgery. Endoscopy 2023; 55: E274-E275

Publikationsverlauf

Artikel online veröffentlicht:
18. November 2024