Role of pancreatoscopy in the management of suspected and confirmed intraductal papillary mucinous neoplasm of the pancreas

Table 1 Studies of intraoperative pancreatoscopy in the management of intraductal papillary mucinous neoplasm, n (%)

Ref.	Study design and patients	Study period	Pre-operative imaging	IPMN types included	IOP approach (open vs MIS)	Additional lesions detected by IOP	Surgical plans change rate	Change of plan based on visual findings or intraductal biopsy	Notable findings
Kaneko et al[38], 1998	Prospective single centre (Japan); 24 patients with IPMN (14 MD, 5 mixed, 5 BD)	1992-1996	EUS, ERCP and CT (all patients)	MD, BD, mixed (all types)	Open surgery; ultrathin scope (3 mm)	10 occult lesions in 24 (42)	3/24 (12.5%)	Visual findings	First demonstration of IOP; guided extended resection in 3 patients; pathology of skips not all reported
Navez et al[37], 2015	Retrospective single-centre (Belgium); 21 patients (all had dilated main pancreatic duct)	1991-2014	CT, MRCP and EUS (all patients)	Mostly MD ± mixed	Open (laparotomy); 3 mm fiberscope with biopsies	8 occult lesions in 21 (38)	5/21 (23.8%)	Intraductal biopsies	Biopsies via IOP showed 3 carcinoma in situ and 2 invasive cancers, prompting 3 completion TPs and 2 extended resections; 90% 5-year disease-free survival reported
Pucci et al[36], 2014	Retrospective multi-centre (Italy); 23 patients out of 1016 pancreatic surgeries	2005-2012	EUS, ERCP or MRCP	Mostly presumed MD (78%)	Open; choledochoscope	5 occult lesions in 23 (22)	5/23 (22%)	Visual findings	IOP altered management in 5 cases (extended resection); one of first multi-centre reports; most patients underwent Whipple’s procedure
Yang et al[35], 2023	Retrospective single-centre (South Korea); 28 patients (all had IOP)	2007-2020	CT, MRCP and EUS (all patients)	MD and mixed only	MIS predominant (75% laparoscopic pancreatoduodenectomy)	5 occult lesions in 28 (18)	5/28 (18%)	Visual findings	All cases were pancreatoduodenectomy; IOP performed laparoscopically; extended resection (completion TP) done in those 5 cases; no difference in disease-free survival vs historic controls with frozen section only

BD: Branch duct; CT: Computed tomography; ERCP: Endoscopic retrograde cholangiopancreatography; EUS: Endoscopic ultrasound; IOP: Intraoperative pancreatoscopy; IPMN: Intraductal papillary mucinous neoplasms; MD: Main duct; MIS: Minimally invasive surgery; MRCP: Magnetic resonance cholangiopancreatography; TP: Total pancreatectomy.