INTRAOPERATIVE PANCREATOSCOPY WITH THE ULTRATHIN PANCREATOSCOPE FOR MUCIN-PRODUCING TUMORS OF THE PANCREAS

Objective: To evaluate the diagnostic accuracy of intraoperative pancr eatoscopy with the ultrathin pancreatoscope for the main pancreatic le sions of mucin-producing tumors of the pancreas (MPT). Design: Prospec tive diagnostic test study with a criterion standard of pathologic exa mination and masked comparison. Setting: A university hospital. Patien ts: Twenty-foul consecutive patients with MPT referred for surgery in whom endoscopic retrograde pancreatography, endoscopic ultrasonography , and computed tomography had been performed as a diagnostic examinati on. All patients underwent surgery and the diagnosis was confirmed by pathologic examination. Intervention: Intraoperative pancreatoscopy wa s performed with the ultrathin pancreatoscope. Main Outcome Measures: Findings of intraoperative pancreatoscopy, endoscopic retrograde pancr eatography, and endoscopic ultrasonography were confirmed by pathologi c examination of resected specimens. The diagnostic accuracy of these 3 modalities in detection of MPT lesions in the main pancreatic duct w as compared. Results: The diagnostic criterion of MPT lesions in the m ain pancreatic duct by intraoperative pancreatoscopy was a granular an d papillary mural nodule. An MPT lesion in the main pancreatic duct wa s found in 17 of 24 cases. Intraoperative pancreatoscopy detected 10 c ases of intraductal MPT lesions that could not be detected by endoscop ic ultrasonography or endoscopic retrograde pancreatography. Five of 1 0 cases were intraductal multicentric lesions. In 3 of these 5, additi onal pancreatic resection was performed. For diagnosis of MPT lesions, the sensitivity, specificity, and overall accuracy of intraoperative pancreatoscopy were all 100%; respective values were 43.8%, 100%, and 60.9% for endoscopic retrograde pancreatography and 47%, 100%, and 62. 5% for endoscopic ultrasonography. Conclusions: Intraoperative pancrea toscopy is safe and effective in diagnosing the intrapancreatic duct-e xtension and multicentric lesions of MPT. It provides important inform ation for operative strategy and contributes to successful pancreatic surgery.