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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(11): E1401-E1410
DOI: 10.1055/a-2452-2919
Original article

Digital peroral pancreatoscopy to determine surgery for patients who have intraductal papillary mucinous neoplasms of the pancreas with mural nodules

Shinsuke Koshita 
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Yutaka Noda
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Yoshihide Kanno 
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Takahisa Ogawa 
2   Department of Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Hiroaki Kusunose
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Toshitaka Sakai
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Keisuke Yonamine
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Kazuaki Miyamoto
2   Department of Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Fumisato Kozakai
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Haruka Okano 
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Yuto Matsuoka
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Kento Hosokawa
2   Department of Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Hidehito Sumiya
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Masaya Oikawa
3   Surgery, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Takashi Tsuchiya
3   Surgery, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Takashi Sawai
4   Pathology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
,
Kei Ito
1   Gastroenterology, Public Interest Incorporated Foundation Sendai City Medical Center, Sendai, Japan (Ringgold ID: RIN506803)
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Abstract

Background and study aims Because more than a few patients have intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with mural nodules (MNs) that are benign, clinical plans should be determined by using histocytological specimens especially, for patients with high risk for surgery or with a small MN.

Patients and methods This study included 27 patients to evaluate the efficacy of peroral pancreatoscopy using a SpyGlass DS system (POPS-DS) for patients with MN-positive IPMN, mainly focusing on the ability of POPS-DS to detect malignancy.

Results Biopsy specimens obtained under POPS-DS guidance could be used for histological evaluation of all patients with MNs in the main pancreatic duct and 67% of the patients with MNs in the branch ducts, whereas fluid specimens collected during POPS-DS could be used for histocytological evaluation for all patients. For the 13 patients who underwent surgery just after POPS-DS, the sensitivity, specificity, and accuracy of POPS-DS to detect malignancy were 89%, 100%, and 92%, respectively. For the 12 patients who underwent surveillance without surgery, the cumulative 3-year progression rates for nine benign IPMNs and three malignant ones determined using POPS-DS were 0% and 100%, respectively. However, the sensitivity of POPS to detect IPMN epithelium in the resection margin was 20%. Only one patient developed procedure-related pancreatitis (mild).

Conclusions POPS-DS could be used to accurately detect malignancy in patients with MN-positive IPMN. Therefore, histocytological evaluation using POPS-DS can contribute to selection of patients for whom surgery would be appropriate.

Keywords

Pancreatobiliary (ERCP/PTCD) - Pancreatoscopy - Endoscopic ultrasonography - Pancreas - Tissue diagnosis

Supplementary Material



Publication History

Received: 22 May 2024

Accepted after revision: 25 October 2024

Accepted Manuscript online:
28 October 2024

Article published online:
28 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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