Parbhu Sheeva K, Siddiqui Ali A, Murphy Megan, Noor Arish, Taylor Linda J, Mills Alyssa, Adler Douglas G
*Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT †Jefferson University School of Medicine, Gastroenterology and Hepatology, Philadelphia, PA.
J Clin Gastroenterol. 2017 Nov/Dec;51(10):e101-e105. doi: 10.1097/MCG.0000000000000796.
Per-oral pancreatoscopy can be used for both evaluation and treatment of pancreatic duct stones during endoscopic retrograde cholangiopancreatography, evaluating and treating pancreatic duct strictures of indeterminate etiology, and visual inspection and direct biopsy of pancreatic duct mucosa for diagnosis of intraductal papillary mucinous neoplasm (IPMN). We aim to describe the efficacy, safety, and outcomes of pancreatoscopy in a large, multicenter series of patients.
A multicenter retrospective review was conducted of all patients who underwent per-oral pancreatoscopy at 2 large tertiary-care medical centers. Review of relevant medical records, laboratory data, imaging studies, endoscopic procedure notes, telephone follow-up notes, and progress notes was performed.
Thirty-three patients underwent 41 pancreatoscopy procedures. Indications included: 20 (48.8%) for diagnosis and treatment of pancreatic duct stones, 16 (39%) for investigation of IPMN, and 5 (12.2%) for evaluation of pancreatic duct strictures.In 20 procedures performed for stone disease, complete pancreatic duct clearance was achieved in 17 of 20 (85%) cases. Strictures were successfully dilated in 5 of 5 (100%) procedures. Direct visualization and biopsy demonstrated IPMN in 11 of 11 (100%) cases. Adverse events occurred in 3 of 41 (7.3%) of procedures, all of which were mild.
In this large series, we demonstrate that in patients with difficult to manage stone disease, strictures and possible malignant ductal pathology, pancreatoscopy is an effective and safe tool that can facilitate both diagnosis and effective therapy. Adverse events in our study were mild and within acceptable limits, further demonstrating that this is a safe procedure that should be offered to appropriate patients.
经口胰管镜检查可用于在内镜逆行胰胆管造影术期间评估和治疗胰管结石、评估和治疗病因不明的胰管狭窄，以及对胰管黏膜进行直视检查和直接活检以诊断导管内乳头状黏液性肿瘤（IPMN）。我们旨在描述在一个大型多中心患者系列中胰管镜检查的疗效、安全性和结果。
对在2家大型三级医疗中心接受经口胰管镜检查的所有患者进行了多中心回顾性研究。对相关病历、实验室数据、影像学检查、内镜检查记录、电话随访记录和病程记录进行了审查。
33例患者接受了41次胰管镜检查。适应证包括：20例（48.8%）用于诊断和治疗胰管结石，16例（39%）用于IPMN的检查，5例（12.2%）用于评估胰管狭窄。在针对结石病进行的20次检查中，20例中的17例（85%）实现了胰管结石的完全清除。5例针对狭窄的检查中，5例（100%）成功进行了扩张。11例针对IPMN的检查中，11例（100%）通过直接观察和活检确诊。41次检查中有3次（7.3%）发生不良事件，均为轻度。
在这个大型系列研究中，我们证明对于难以处理的结石病、狭窄以及可能的恶性导管病变患者，胰管镜检查是一种有效且安全的工具，有助于诊断和有效治疗。我们研究中的不良事件为轻度且在可接受范围内，进一步证明这是一种安全的检查方法，应提供给合适的患者。
