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World J Gastrointest Endosc. Jan 16, 2019; 11(1): 22-30
Published online Jan 16, 2019. doi: 10.4253/wjge.v11.i1.22
Pancreatoscopy: An update
Luca De Luca, Alessandro Repici, Adea Koçollari, Francesco Auriemma, Mario Bianchetti, Benedetto Mangiavillano
Luca De Luca, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Piazzale Cinelli, Pesaro 61121, Italy
Alessandro Repici, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano 20089, Italy
Alessandro Repici, Benedetto Mangiavillano, Humanitas University, Pieve Emanuele 20090, Italy
Adea Koçollari, Gastroenterology Unit, University Medical Center “Mother Theresa” Hospital, Tirana 1000, Albania
Francesco Auriemma, Mario Bianchetti, Benedetto Mangiavillano, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
Author contributions: All authors contributed equally to this manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luca De Luca, MD, Doctor, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Piazzale Cinelli 1, Pesaro 61121, Italy. lucadeluca1210@gmail.com
Telephone: +39-721-362288 Fax: +39-721-362285
Received: September 28, 2018
Peer-review started: September 28, 2018
First decision: October 23, 2018
Revised: December 21, 2018
Accepted: December 29, 2018
Article in press: December 30, 2018
Published online: January 16, 2019
Processing time: 110 Days and 14.8 Hours
Abstract

Per-oral pancreatoscopy (POPS) is an endoscopic procedure to visualize the main pancreatic duct. POPS specifically has the advantage of direct visualization of the pancreatic duct, allowing tissue acquisition and directed therapies such as stones lithotripsy. The aim of this review is to analyze and summarize the literature around pancreatoscopy. Pancreatoscopy consists of the classic technique of the mother-baby method in which a mini-endoscope is passed through the accessory channel of the therapeutic duodenoscope. Pancreatoscopy has two primary indications for diagnostic purpose. First, it is used for visualization and histological diagnosis of intraductal papillary mucinous neoplasms. In these cases, POPS is very useful to assess the extent of malignancy and for the study of the intraductal papillary mucinous neoplasm in order to guide the surgery resection margins. Second, it is used to determine pancreatic duct strictures, particularly important in cases of chronic pancreatitis, which is associated with both benign and malignant strictures. Therefore POPS allows differentiation between benign and malignant disease and allows mapping the extent of the tumor prior to surgical resection. Also tissue sampling is possible, but it can be technically difficult because of the limited maneuverability of the biopsy forceps in the pancreatic ducts. Pancreatoscopy can also be used for therapeutic purposes, such as pancreatoscopy-guided lithotripsy in chronic painful pancreatitis with pancreatic duct stones. The available data for the moment suggests that, in selected patients, pancreatoscopy has an important and promising role to play in the diagnosis of indeterminate pancreatic duct strictures and the mapping of main pancreatic duct intraductal papillary mucinous neoplasms. However, further studies are necessary to elucidate and validate the pancreatoscopy role in the therapeutic algorithm of chronic pancreatitis.

Keywords: Pancreatoscopy; Per-oral pancreatoscopy; Endoscopic retrograde cholangiopancreatography; SpyGlass

Core tip: Multiple modalities are available for the investigation of pancreatic diseases, such as magnetic resonance cholangiopancreatography, computed tomography, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. Per-oral pancreatoscopy was initially described in 1976. The available data suggests that in selected patients pancreatoscopy plays an important role in indeterminate pancreatic duct strictures and in evaluating the main pancreatic duct for intraductal papillary mucinous neoplasms following endoscopic ultrasound-fine needle aspiration prior to surgical treatment. Considering its therapeutic role, per-oral pancreatoscopy with lithotripsy has achieved a high rate of ductal clearance in patients with chronic calcific pancreatitis.