title: Intracystic Biopsy and Diagnosis of Intraductal Papillary Mucinous Neoplasm via SpyGlass Pancreatoscopy.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasm (IPMN) of the pancreas carries a risk of malignancy ranging from 15%-60%, depending on certain high-risk features. Diagnostic efforts often include radiographic imaging with computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, and endoscopic ultrasound. Once IPMN has been diagnosed, the proposed indications for cyst resection are based primarily on size, main duct involvement, symptoms, and the presence of mural nodules. Diagnostic difficulty still remains, however, in patients with small lesions and with normal carcinoembryonic antigen levels, so alternative endoscopic modalities are needed.
  
  
  METHODS
  We report a case of intracystic SpyGlass Direct Visualization System (Boston Scientific) evaluation and biopsy of an IPMN in a 74-year-old male patient who presented to our surgical clinic with a history of chronic pancreatitis and significant weight loss during the last 2½ years.
  
  
  CONCLUSIONS
  In difficult diagnostic cases, SpyGlass pancreatoscopy can be quite useful because the device allows direct endoscopic visualization of the pancreaticobiliary ducts. Ductal pathology, including stones, strictures, and proliferative epithelial abnormalities, can be observed and even directly biopsied. Early experience in applying this technology to pancreatic cyst evaluation has indicated improved diagnostic accuracy.
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Shoichiro A
authors.initials: SA
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology, Digestive Health Center, Ocean Springs, MS.
authors.forename: John D
authors.initials: JD
authors.lastname: McKee
authors.affiliation: Department of Surgery, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: W Charles
authors.initials: WC
authors.lastname: Conway
keywords: Carcinoma–pancreatic ductal; image-guided biopsy; pancreatectomy; pancreatic neoplasms; pancreatitis