IS PANCREATOSCOPY OF ANY BENEFIT IN CLARIFYING THE DIAGNOSIS OF PANCREATIC DUCT LESIONS

Background and Study Aims: Modern fine-caliber endoscopes enable clini cians to directly visualize the pancreatic duct. They allow intraducta l manipulation under optical control. We tried to evaluate the additio nal diagnostic potential of pancreatoscopy in assessing inconclusive i ntraductal pancreatic changes. Patients and Methods: We prospectively performed 20 pancreatoscopies in 18 patients with inconclusive ductal abnormalities that had been previously investigated by computed tomogr aphy (CT) scan, abdominal ultrasound and endoscopic retrograde cholang iopancreatography (ERCP), The CHF-BP 30 (Olympus Optical Co., Japan) e ndoscope with an outer diameter of 3.1 mm and an instrumentation chann el of 1.2 mm was used. Biopsies, cytological brushing and fluid collec tion were carried out, and the site of ductal abnormality was visualiz ed, Endoscopic sphincterotomy (EST) was carried out in every patient p rior to insertion of the pancreatoscope. Results: Seven intraductal tu mors were histologically confirmed, i.e. five intraductal papillary mu cinous tumors and two adenocarcinomas. Benign appearance of the intrad uctal lesion plus negative histopathological examinations were confirm ed by a follow-up of two years in eight patients. Five had chronic pan creatitis, and a further three had pancreatitis with strictures, blood clot obstruction, and idiopathic benign structure, respectively. Ther e were no complications with the exception of one bleeding episode aft er EST; no pancreatitis occurred. Conclusions: Pancreatoscopy is of di agnostic value in addition to CT, transabdominal ultrasound and ERCP i n the differential diagnosis of poorly defined pancreatic lesions, par ticularly when assessing alterations of the ductal caliber without par enchymatous lesions.