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DOI: 10.1055/s-0030-1256436
© Georg Thieme Verlag KG Stuttgart · New York
Overtube-assisted direct peroral pancreatoscopy using an ultraslim gastroscope in a patient suspected of having an intraductal papillary mucinous neoplasm
V. PrachayakulMD
Siriraj Endoscopy Center
Siriraj Hospital –
Internal medicine
Prannok Road
Bangkok 10700
Thailand
Fax: +66-2411-5013
Email: psprvaks@gmail.com
Publication History
Publication Date:
13 September 2011 (online)
A 68-year-old man who had presented with abdominal discomfort and undergone a computed tomography (CT) scan that had revealed cystic lesions in the pancreatic head was referred to us for endoscopic ultrasound (EUS). The endoscopic view showed a fish-mouth opening to the ampulla with mucin content ([Fig. 1]).
EUS revealed a dilated pancreatic duct, approximately 1.7 cm in diameter, with a narrowing in the pancreatic head but with no mass seen. There were a few cystic lesions in the body of the pancreas and the pancreatic parenchyma showed evidence of chronic pancreatitis. The diagnosis of mixed-type intraductal papillary mucinous neoplasm was made ([Fig. 2]).
He was scheduled for pancreatoscopy to evaluate the pancreatic duct and biopsy any suspected malignant transformation.
It was decided to perform overtube-assisted direct peroral pancreatoscopy with an ultraslim gastroscope because the pancreatic duct size was more than 1 cm and the image quality would be better than with a mother–baby scope system. Before the procedure, a hole was made in the overtube of a single-balloon enteroscope (ST-SB1; Olympus, Tokyo, Japan) at 70 cm from the distal tip of the overtube ([Fig. 3]).
First, pancreatic duct cannulation and sphincterotomy were performed through a duodenoscope, and a 0.035-inch guide wire was left in the pancreatic duct. An ultraslim gastroscope (GIF-N260, scope diameter 5.9 mm, working channel 2.0 mm; Olympus) was then passed over the guide wire with the assistance of the overtube, without balloon inflation, to reduce stomach looping and maintain a straight position for the scope ([Fig. 4]). Once at the ampulla, the ultraslim gastroscope was advanced without the overtube further along the guide wire into the pancreatic duct.
Pancreatoscopy showed normal pancreatic duct mucosa; the stricture point was visualized, but there was no evidence of a mural nodule or mass ([Fig. 5]). The patient tolerated the procedure well without complications. He was referred for a Whipple operation a few weeks later.
In this case, in contrast to the techniques described by other endoscopists [1] [2], we used the assistance of the overtube without balloon inflation. In our experience, direct peroral cholangiopancreatoscopy with overtube assistance makes the procedure easier and shortens the ductal intubation time.
Endoscopy_UCTN_Code_TTT_1AR_2AK
Competing interests: None
#References
- 1 Krishna S G, McElreath D P, Rego R F. Direct pancreatoscopy with an ultrathin forward-viewing endoscope in intraductal papillary mucinous neoplasm of the pancreas. Clin Gastroenterol Hepatol. 2009; 7 e75-e76
- 2 Ringold D A, Yen R D, Chen Y K. Direct dorsal pancreatoscopy with narrow-band imaging for the diagnosis of intraductal papillary mucinous neoplasm and pancreas divisum (with video). Gastrointest Endosc. 2010; 72 1263-1264
V. PrachayakulMD
Siriraj Endoscopy Center
Siriraj Hospital –
Internal medicine
Prannok Road
Bangkok 10700
Thailand
Fax: +66-2411-5013
Email: psprvaks@gmail.com
References
- 1 Krishna S G, McElreath D P, Rego R F. Direct pancreatoscopy with an ultrathin forward-viewing endoscope in intraductal papillary mucinous neoplasm of the pancreas. Clin Gastroenterol Hepatol. 2009; 7 e75-e76
- 2 Ringold D A, Yen R D, Chen Y K. Direct dorsal pancreatoscopy with narrow-band imaging for the diagnosis of intraductal papillary mucinous neoplasm and pancreas divisum (with video). Gastrointest Endosc. 2010; 72 1263-1264
V. PrachayakulMD
Siriraj Endoscopy Center
Siriraj Hospital –
Internal medicine
Prannok Road
Bangkok 10700
Thailand
Fax: +66-2411-5013
Email: psprvaks@gmail.com