Pancreatoscopy in the evaluation and management of pancreatic disorders

Abstract

Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct. Its relevance has grown in recent years with the introduction of novel technologies, allowing for both diagnosis and treatment within a single procedure. In therapeutic applications, it facilitates interventions such as stone fragmentation, stone retrieval, and tumor-related obstruction management. In diagnostic applications, it improves the accuracy of biopsies for suspicious lesions, particularly in cases of cystic neoplasms, indeterminate strictures, and pancreatic fistula assessments. The most common complications include post-procedural pancreatitis and self-limited abdominal pain, with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement. Despite being limited by the need for specialized equipment and trained personnel, technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.

Keywords: Chronic pancreatitis; Endoscopy; Pancreas; Pancreatic duct stones; Pancreatic intraductal neoplasms; Pancreatoscopy.

Figure 1

Fluoroscopic pancreatogram obtained during pancreatoscopy.

Figure 2

Normal pancreatic duct.

Figure 3

Intraductal papillary mucinous neoplasm. A: Villous projections from a main-duct intraductal papillary mucinous neoplasm; B: SpyBite forceps used to perform a direct biopsy of a suspected intraductal papillary mucinous neoplasm; C: Intraductal papillary mucinous neoplasm and pancreatic stones.

Figure 4

Main pancreatic duct stricture due to chronic pancreatitis.

Figure 5

Fluoroscopy showing a tortuous pancreatic duct in chronic pancreatitis.

Figure 6

Stone lithotripsy. A: Laser lithotripsy of a main pancreatic duct stone; B: Pancreatic side-branch stones; C: Electrohydraulic lithotripsy for main pancreatic duct stone fragmentation.