VideoGIE| Volume 84, ISSUE 6, P1060-1061, December 2016

Digital pancreatoscopy in the management of main duct intraductal papillary mucinous neoplasm

      A 69-year-old man presented with an incidental finding of a diffusely dilatated pancreatic duct to 18 mm on CT performed for evaluation of emphysema. Magnetic resonance imaging showed an additional 12-mm mural nodule in a side branch duct in the tail of the pancreas. A multidisciplinary tumor board agreed during discussion that performing a segmental distal pancreatectomy to remove the nodule might not be of benefit if there were high-risk lesions in the proximal pancreatic duct, given the diffusely dilatated pancreatic duct without obvious lesions of the proximal main duct. Therefore, pancreatoscopy was performed to rule out high-risk lesions in the head or neck of the pancreatic duct. Digital pancreatoscopy revealed a dilated head and neck of the pancreatic duct, but the duct was otherwise normal (Fig. 1A; Video 1, available online at Mucin was seen in the neck of the pancreatic duct, and this explained the diffuse duct dilatation (Fig. 1B). There was a discrete transition in the body of the pancreatic duct to a duct lined with papillary fronds consistent with intraductal papillary mucinous neoplasm (Fig. 1C). Given the pancreatoscopy findings, the patient underwent segmental body and tail pancreatectomy. Digital pancreatoscopy can define anatomy that can aid in surgical management of main duct intraductal papillary mucinous neoplasm.
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      Figure 1Pancreatoscopy images showing A, normal epithelium in a dilated head of pancreas duct; B, a dilated neck of pancreas duct with mucin; and C, body of the pancreas duct with papillary fronds consistent with intraductal papillary mucinous neoplasm.
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