Tanaka Shoichiro A, McKee John D, Conway W Charles
Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
Department of Gastroenterology, Digestive Health Center, Ocean Springs, MS.
Ochsner J. 2015 Winter;15(4):452-4.
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas carries a risk of malignancy ranging from 15%-60%, depending on certain high-risk features. Diagnostic efforts often include radiographic imaging with computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, and endoscopic ultrasound. Once IPMN has been diagnosed, the proposed indications for cyst resection are based primarily on size, main duct involvement, symptoms, and the presence of mural nodules. Diagnostic difficulty still remains, however, in patients with small lesions and with normal carcinoembryonic antigen levels, so alternative endoscopic modalities are needed.
We report a case of intracystic SpyGlass Direct Visualization System (Boston Scientific) evaluation and biopsy of an IPMN in a 74-year-old male patient who presented to our surgical clinic with a history of chronic pancreatitis and significant weight loss during the last 2½ years.
In difficult diagnostic cases, SpyGlass pancreatoscopy can be quite useful because the device allows direct endoscopic visualization of the pancreaticobiliary ducts. Ductal pathology, including stones, strictures, and proliferative epithelial abnormalities, can be observed and even directly biopsied. Early experience in applying this technology to pancreatic cyst evaluation has indicated improved diagnostic accuracy.
胰腺导管内乳头状黏液性肿瘤（IPMN）具有15% - 60%的恶性风险，具体取决于某些高危特征。诊断方法通常包括利用计算机断层扫描、磁共振成像、磁共振胰胆管造影和内镜超声进行影像学检查。一旦诊断出IPMN，建议进行囊肿切除的指征主要基于囊肿大小、主胰管受累情况、症状以及壁结节的存在。然而，对于小病变且癌胚抗原水平正常的患者，诊断仍存在困难，因此需要其他内镜检查方式。
我们报告一例74岁男性患者，其因慢性胰腺炎病史且在过去2年半内体重显著减轻而就诊于我们的外科门诊，该患者接受了囊内SpyGlass直视系统（波士顿科学公司）对IPMN的评估和活检。
在诊断困难的病例中，SpyGlass胰管镜检查可能非常有用，因为该设备可实现胰胆管的直接内镜可视化。可以观察到包括结石、狭窄和增生性上皮异常在内的导管病变，甚至可直接进行活检。将该技术应用于胰腺囊肿评估的早期经验表明诊断准确性有所提高。
