Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 155-167
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.155
Role of pancreatoscopy in management of pancreatic disease: A systematic review
Tarun Kaura, Field F Willingham, Saurabh Chawla
Tarun Kaura, Division of Gastroenterology and Hepatology, Aurora St Luke’s Medical center, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI 53215, United States
Field F Willingham, Saurabh Chawla, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: All authors equally contributed to this paper with conception and design, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: All authors declare no potential conflicts of interest. No financial support.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Saurabh Chawla, FACG, MD, Associate Professor, Division of Digestive Diseases, Department of Internal Medicine, Emory University School of Medicine, Faculty Office Building, 49 Jesse Hill Jr. Drive, Suite 431, Atlanta, GA 30303, United States. saurabh.chawla@emory.edu
Telephone: +1-404-7781684 Fax: +1-404-2780277
Received: November 3, 2018
Peer-review started: November 5, 2018
First decision: November 28, 2018
Revised: December 30, 2018
Accepted: January 23, 2019
Article in press: January 23, 2019
Published online: February 16, 2019
Processing time: 107 Days and 5.5 Hours
Abstract
BACKGROUND

Per-oral pancreatoscopy (POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.

AIM

To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.

METHODS

To determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid. Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound (IDUS) and POP combined with image-enhancing technology.

RESULTS

The success rate for complete ductal stone clearance ranged from 37.5%-100%. Factors associated with failure included the presence of strictures, multiple stones and the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy, and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.

CONCLUSION

Current evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.

Keywords: Pancreatoscopy; Cholangiopancreatoscopy; Chronic pancreatitis; Pancreatic duct stones; Intraductal papillary mucinous neoplasm; Pancreatic cancer; Pancreatic duct stricture

Core tip: This updated review focuses on the current evidence regarding the use of per oral pancreatoscopy (POP) in the management of complex pancreatic ductal diseases. Traditionally, treatment of pancreatic stone disease has been performed by endoscopic retrograde cholangiopancreatography; POP may fill a void, offering durable relief while avoiding surgery in certain scenarios. POP also plays a complementary role to endoscopic ultrasonography in the evaluation of pancreatic ductal abnormalities with suspicion of neoplasia. With rapid advancements in imaging technology, POP may play a wider therapeutic role in the treatment of pancreatic ductal neoplasia.