title: Peroral pancreatoscopy using the SpyGlass system for the assessment of intraductal papillary mucinous neoplasm of the pancreas.
abstract: BACKGROUND
  Peroral pancreatoscopy (POPS) using a mother-baby endoscope system is often useful for assessment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with main pancreatic duct (MPD) involvement, but is not widely used for several reasons. The aim of this study was to evaluate the usefulness of the SpyGlass Direct Visualization System for assessment of IPMN.
  
  
  METHODS
  Seventeen patients diagnosed with possible IPMN with MPD dilation underwent peroral pancreatoscopy using the SpyGlass system at our institution. The quality of visualization and the sensitivities of cytological and pathological investigations for diagnosing malignant lesions were evaluated.
  
  
  RESULTS
  Peroral pancreatoscopy was performed using the SpyScope in 12 patients and an endoscopic retrograde cholangiopancreatography (ERCP) catheter in five patients. Sufficient visualization was achieved in 92% of cases using the SpyScope and 40% of cases using the ERCP catheter. Biopsy under direct visualization was successful in seven patients. Biopsy specimens showed adenocarcinoma in one patient, benign neoplastic epithelium in five patients, and regenerative changes in one patient; and had 25% sensitivity and 100% specificity for detecting malignancy. SpyGlass pancreatoscopy with irrigation cytology had 100% sensitivity and 100% specificity for detecting malignancy. SpyGlass pancreatoscopy was useful for determining the operative excision line in three patients. There were no severe procedure-related adverse events.
  
  
  CONCLUSIONS
  Peroral pancreatoscopy using the SpyGlass system seems to be feasible and useful for assessment of IPMN with a dilated MPD.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nagayoshi
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kono
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Hisato
authors.initials: H
authors.lastname: Igarashi
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009055:Mouth; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods / Q000401:mortality; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Intraductal papillary mucinous neoplasm; Pancreatoscopy; SpyGlass