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CC BY 4.0 · Endoscopy 2024; 56(S 01): E183
DOI: 10.1055/a-2261-7642
E-Videos

An unusual pancreas divisum intraductal papillary mucinous neoplasm diagnosed by pancreatoscopy-assisted endoscopic ultrasonography rendezvous procedure

Belén Agudo Castillo 
1   Department of Gastroenterology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Daniel de la Iglesia 
1   Department of Gastroenterology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Carlos Esteban Fernández-Zarza
1   Department of Gastroenterology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Esther Maderuelo González
1   Department of Gastroenterology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Ana Isabel Cabrero Cabrero
1   Department of Gastroenterology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Paula Aguirre-Camino
2   Department of Radiology, Puerta de Hierro University Hospital, Majadahonda, Spain
,
Mariano González-Haba Ruiz
2   Department of Radiology, Puerta de Hierro University Hospital, Majadahonda, Spain
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This video case report presents the endoscopic management of a main duct intraductal papillary mucinous neoplasm (IPMN) in a 75-year-old patient with a history of acute pancreatitis.

The patient presented at the emergency department with an episode of acute pancreatitis. Based on endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), a main duct IPMN was suspected with a pancreas divisum. A pancreatoscopy to establish the extension of the main duct IPMN was planned prior to surgery ([Video 1]) [1] [2]. Pancreatoscopy through the major papilla revealed typical features of IPMN, such as mucinous secretion and papillary mucosal changes. However, due to the anatomical complexity associated with pancreas divisum, a complete examination of the dorsal pancreas was not feasible through this approach. To overcome the limitations posed by pancreas divisum and the impossibility to identify the minor papilla during endoscopic retrograde cholangiopancreatography (ERCP) [3], a rendezvous procedure was undertaken ([Fig. 1]). Utilizing EUS guidance, a guidewire was passed through the minor papilla and through the use of this guidewire, the pancreatoscope was advanced to the dorsal pancreas via the minor papilla. This innovative approach provided a comprehensive view of the pancreatic ductal system.

Endoscopic evaluation of a main duct intraductal papillary mucinous neoplasm in a patient with pancreas divisum.Video 1

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Fig. 1 Endoscopic ultrasound-guided rendezvous technique.

The video demonstrates a normal dorsal pancreas and Santorini duct, confirming the absence of pathological changes in these regions. This comprehensive examination led to a final diagnosis of ventral duct IPMN, with no involvement of the dorsal pancreatic duct. The video highlights the importance of a thorough and tailored endoscopic approach in patients with complex pancreatic anatomy like pancreas divisum.

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Endoscopy E-Videos https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Daniel de la Iglesia, MD, PhD
Gastroenterology Department, University Hospital of Puerta de Hierro
Manuel de Falla 1
28222 Majadahonda
Spain   

Publication History

Article published online:
22 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Fig. 1 Endoscopic ultrasound-guided rendezvous technique.