Subscribe to RSS
DOI: 10.1055/a-2261-7642
An unusual pancreas divisum intraductal papillary mucinous neoplasm diagnosed by pancreatoscopy-assisted endoscopic ultrasonography rendezvous procedure
This video case report presents the endoscopic management of a main duct intraductal papillary mucinous neoplasm (IPMN) in a 75-year-old patient with a history of acute pancreatitis.
The patient presented at the emergency department with an episode of acute pancreatitis. Based on endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), a main duct IPMN was suspected with a pancreas divisum. A pancreatoscopy to establish the extension of the main duct IPMN was planned prior to surgery ([Video 1]) [1] [2]. Pancreatoscopy through the major papilla revealed typical features of IPMN, such as mucinous secretion and papillary mucosal changes. However, due to the anatomical complexity associated with pancreas divisum, a complete examination of the dorsal pancreas was not feasible through this approach. To overcome the limitations posed by pancreas divisum and the impossibility to identify the minor papilla during endoscopic retrograde cholangiopancreatography (ERCP) [3], a rendezvous procedure was undertaken ([Fig. 1]). Utilizing EUS guidance, a guidewire was passed through the minor papilla and through the use of this guidewire, the pancreatoscope was advanced to the dorsal pancreas via the minor papilla. This innovative approach provided a comprehensive view of the pancreatic ductal system.
Quality:
The video demonstrates a normal dorsal pancreas and Santorini duct, confirming the absence of pathological changes in these regions. This comprehensive examination led to a final diagnosis of ventral duct IPMN, with no involvement of the dorsal pancreatic duct. The video highlights the importance of a thorough and tailored endoscopic approach in patients with complex pancreatic anatomy like pancreas divisum.
Endoscopy_UCTN_Code_TTT_1AS_2AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website athttps://mc.manuscriptcentral.com/e-videos.
Publication History
Article published online:
22 February 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 De Jong DM, Stassen PMC, Groot Koerkamp B. et al. The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis. Endoscopy 2023; 55: 25-35
- 2 Arnelo U, Valente R, Scandavini CM. et al. Intraoperative pancreatoscopy can improve the detection of skip lesions during surgery for intraductal papillary mucinous neoplasia: A pilot study. Pancreatology 2023; 23: 704-711
- 3 Chew EY, Varghese BT, Sealock RJ. Pancreatic duct rendezvous with pancreatoscopy through the minor papilla. VideoGIE 2018; 3: 132-134 DOI: 10.1016/j.vgie.2018.01.004. (PMID: 29916462)