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
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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