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Meta-Analysis
. 2023 Jan;55(1):25-35.
doi: 10.1055/a-1869-0180. Epub 2022 Jun 3.

The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis

David M de Jong #  1 , Pauline M C Stassen #  1 , Bas Groot Koerkamp  2 , Mark Ellrichmann  3 , Petko I Karagyozov  4 , Andrea Anderloni  5 , Leena Kylänpää  6 , George J M Webster  7   8 , Lydi M J W van Driel  1 , Marco J Bruno  1 , Pieter J F de Jonge  1 ; European Cholangioscopy study group
Affiliations
Meta-Analysis

The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis

David M de Jong et al. Endoscopy. 2023 Jan.

Abstract

Background: Confirming the diagnosis, invasiveness, and disease extent of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is challenging. The aim of this study was to summarize the literature on the efficacy and safety of peroral pancreatoscopy (POP) in the diagnosis of IPMN, including the impact of pre- and intraoperative POP on the management of IPMN.

Methods: The EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar databases were systematically searched for articles. Eligible articles investigated cohorts of patients who underwent POP for (suspected) IPMN.

Results: 25 articles were identified and included in this review; with 22 of these reporting on the diagnostic yield of POP in IPMN and 11 reporting on the effect of pre- or intraoperative POP on clinical decision-making. Cannulation and observation rates, and overall diagnostic accuracy were high across all studies. Frequently reported visual characteristics of IPMN were intraductal fish-egg-like lesions, hypervascularity, and granular mucosa. Overall, the adverse event rate was 12 %, primarily consisting of post-endoscopic retrograde cholangiopancreatography pancreatitis, with a pooled rate of 10 %, mostly of mild severity. Regarding the impact of POP on clinical decision-making, POP findings altered the surgical approach in 13 %-62 % of patients.

Conclusion: POP is technically successful in the vast majority of patients with (suspected) IPMN, has a consistently high diagnostic accuracy, but an adverse event rate of 12 %. Data on intraoperative pancreatoscopy are scarce, but small studies suggest its use can alter surgical management. Future studies are needed to better define the role of POP in the diagnostic work-up of IPMN.

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Conflict of interest statement

M.J. Bruno received research funding from Boston Scientific, Cook Medical, Pentax Medical, InterScope, and Mylan; he is a consultant to Boston Scientific, Cook Medical, and Pentax Medical. M. Ellrichmann received research funding from Boston Scientific and is a consultant to Boston Scientific. L. Kylänpää is a speaker and consultant for Boston Scientific, Cook Medical, and Olympus. A. Anderloni is a consultant for Boston Scientific. George Webster is a consultant and invited speaker for Boston Scientific, Cook Endoscopy, and Pentax Medical. The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing the selection and exclusion of articles. POP, peroral pancreatoscopy; IPMN, intraductal papillary mucinous neoplasm; CT, computed tomography.
Fig. 2
Fig. 2
Pooled AE rate for all studies that reported adverse events.
Fig. 3
Fig. 3
Example images during peroral pancreatoscopy (POP) in four patients with intraductal papillary mucinous neoplasm (IPMN) showing: a a clear proximal margin of a main-duct IPMN (MD-IPMN) that was suspicious for malignancy, but was found to be a mixed-type IPMN without any malignancy on pancreatoduodenectomy (see also Video 1 ); b a clear image of a visible polypoid lesion in the setting of MD-IPMN, with biopsy revealing focal malignant transformation; c the clear fish-egg-like lesions in an MD-IPMN; d a very wide side branch in the body of the pancreas, with a nodular mass seen at the opening of the side branch, which showed mild dysplasia on POP-guided biopsy and later pancreatoduodenectomy.
See this image and copyright information in PMC

References

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    1. Lafemina J, Katabi N, Klimstra D et al.Malignant progression in IPMN: A cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol. 2013;20:440–447. - PubMed
    1. Tanaka M, Fernandez-del Castillo C, Adsay V et al.International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–197. - PubMed
    1. Tanaka M, Fernández-Del Castillo C, Kamisawa T et al.Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17:738–753. - PubMed
    1. He J, Cameron J L, Ahuja N.Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 2013216657–665.; discussion 665-657 - PMC - PubMed

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