Pancreatoscopy assists in the diagnosis of malignant transformation in chronic pancreatitis

Patients with chronic pancreatitis have an increased risk of pancreatic cancer [1]. Unfortunately, there are no effective screening strategies for early detection of pancreatic cancer in these patients [2]. An active role for pancreatoscopy has been shown in the diagnosis of intraductal papillary mucinous neoplasm (IPMN) [3], in lithotripsy for pancreatic duct stones [4], and in laser stricturoplasty [5]. We describe the case of a patient with chronic pancreatitis in whom malignant transformation was detected by pancreatoscopy, so possibly we should emphasize the diagnostic role of pancreatoscopy in patients with chronic pancreatitis.

A 33-year-old man was admitted to our hospital with intermittent abdominal pain. He had a 10-year history of drinking alcohol and had been diagnosed with acute pancreatitis at another hospital 7 years previously. Magnetic resonance imaging (MRI) showed chronic pancreatitis with stones in the main pancreatic duct ([Fig. 1]). We chose endoscopic ultrasonography (EUS) for further examination (Video 1). EUS revealed dilatation of the pancreatic duct, with stones in the pancreatic duct at the head of the pancreas ([Fig. 2] a) and hypoechoic nodules in the pancreatic duct wall near the stones ([Fig. 2] b), and no “fish mouth” appearance at the major papilla ([Fig. 2] c). To further clarify the diagnosis, endoscopic retrograde cholangiopancreatography (ERCP) was performed and a novel peroral pancreatoscope (eyeMax Pancreatoscope System Digital Controller; Micro-Tech, Nanjing, China) was used subsequently to explore the pancreatic duct ([Video 1]).

Pancreatoscopy-aided diagnosis of malignant transformation in a patient with chronic pancreatitis.Video 1

Fig. 1 Magnetic resonance imaging (MRI) showed chronic pancreatitis with main pancreatic duct stones in a 33-year-old man with intermittent abdominal pain. a Dilatation of the main pancreatic duct. b Pancreatic duct stone (arrow) at the head of the pancreas.

Fig. 2 a Endoscopic ultrasonography (EUS) revealed pancreatic duct stones at the head of the pancreas, including a stone 8.8 mm in diameter. b Hypoechoic nodules (arrow) near the stones. c Endoscopically there was no “fish mouth” appearance or mucus at the major papilla.

Several stones were clearly visible in the main pancreatic duct (MPD) and in partially wide side branches ([Fig. 3] a, c). Proliferative lesions with a fragile surface were seen in the MPD at the head of the pancreas ([Fig. 3] b). No significant mucus was observed in the pancreatic duct. We then performed pancreatoscopy-guided biopsy using a biopsy forceps and successfully removed MPD stones. Pathological examination revealed adenocarcinomatous tissue originating from the epithelium of the pancreatic duct ([Fig. 3] d). A final diagnosis was made of chronic pancreatitis with regional development of cancer .

Fig. 3 a Stones in the main pancreatic duct and the hyperplastic tissue surrounding them. b The surface of the hyperplastic lesion is fragile and rich in tortuous blood vessels. c A stone in the wide branch duct. d Pancreatoscopy-guided biopsy obtained adenocarcinomatous tissue that originated from the epithelium of the pancreatic duct.

Endoscopy_UCTN_Code_TTT_1AR_2AK

 

MissingLinkText

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Hart PA, Conwell DL. Chronic pancreatitis: managing a difficult disease. Am J Gastroenterol 2020; 115: 49-55
• 2 Vege SS, Chari ST. Chronic pancreatitis. N Engl J Med 2022; 386: 869-878
• 3 Trindade AJ, Benias PC, Kurupathi P. et al. Digital pancreatoscopy in the evaluation of main duct intraductal papillary mucinous neoplasm: a multicenter study. Endoscopy 2018; 50: 1095-1098
• 4 Gerges C, Albers D, Schmitz L. et al. Digital single-operator pancreatoscopy for the treatment of symptomatic pancreatic duct stones: a prospective multicenter cohort trial. Endoscopy 2023; 55: 150-157
• 5 Jonica ER, Shah RJ. Pancreatoscopy-guided laser dissection of obstructing pancreatic duct stricture: pancreas-preserving endotherapy. VideoGIE 2022; 7: 146-148

Publikationsverlauf

Artikel online veröffentlicht:
18. November 2024