title: Single-operator pancreatoscopy is helpful in the evaluation of suspected intraductal papillary mucinous neoplasms (IPMN).
abstract: OBJECTIVE
  Even when advanced cross-sectional imaging modalities have been employed, endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMN) is often required in order to assess the final character and extent of lesions. The current study addresses the use of SpyGlass single-operator peroral pancreatoscopy in suspected IPMN.
  
  
  METHODS
  A prospective, non-randomized exploratory cohort study.
  
  
  METHODS
  Single-center.
  
  
  METHODS
  A prospective study-cohort of 44 consecutive patients in a single tertiary referral center who underwent ERCP and peroral pancreatoscopy, was prospectively collected between July 2007 and March 2013 because of a radiological signs of IPMN. These IPMN-findings were discovered incidentally in 44% of the cases.
  
  
  METHODS
  Diagnostic accuracy (specificity & sensitivity) and complications.
  
  
  RESULTS
  The targeted region of the pancreatic duct was reached with the SpyGlass system in 41 patients (median age 65 years, 41% female). Three patients were excluded from analysis because of failed deep cannulation of the pancreatic duct. Brush cytology was taken in 88% and direct biopsies in 41%. IPMN with intermediate or high-grade dysplasia was the main final diagnosis (76%) in 22 patients who had surgery. Out of the 17 patients with a final diagnosis of MD-IPMN, 76% were correctly identified by pancreatoscopy. Of the 9 patients with a final diagnosis of BD-IPMN, the pancreatoscopy identified 78% of the cases correctly.The incidence of post-ERCP pancreatitis was 17%. Pancreatoscopy was found to have provided additional diagnostic information in the vast majority of the cases and to affect clinical decision-making in 76%.
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  Single-operator peroral pancreatoscopy contributed to the clinical evaluation of IPMN lesions and influenced decision-making concerning their clinical management. The problem of post-procedural pancreatitis needs further attention.
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden. Electronic address: urban.arnelo@ki.se.
authors.forename: Urban
authors.initials: U
authors.lastname: Arnelo
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden; Dept. of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Siiki
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Swahn
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Ralf
authors.initials: R
authors.lastname: Segersvärd
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Enochsson
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Marco
authors.initials: M
authors.lastname: del Chiaro
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.affiliation: Division of Pathology, Dept. of Laboratory Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Verbeke
authors.affiliation: Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institute, Stockholm, Sweden.
authors.forename: J-Matthias
authors.initials: JM
authors.lastname: Löhr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019412:Anatomy, Cross-Sectional; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010183:Pancreatic Ducts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D018300:Papilloma, Intraductal / Q000175:diagnosis* / Q000601:surgery; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: ERCP; High-grade dysplasia; IPMN; Pancreatoscopy; Single-operator; SpyGlass