title: Role of per-oral pancreatoscopy in the evaluation of suspected pancreatic duct neoplasia: a 13-year U.S. single-center experience.
abstract: OBJECTIVE
  The role of per-oral pancreatoscopy (POP) in the evaluation of occult pancreatic duct (PD) lesions remains limited to case series. The aim of this study was to evaluate the ability of POP to differentiate malignant from benign diseases of the PD.
  
  
  METHODS
  Patients who underwent POP between 2000 and 2013 for the evaluation of indeterminate PD strictures, dilatations, or with suspected or known main duct intraductal papillary mucinous neoplasm were identified. Main outcome measurements were visual impression accuracy, POP tissue sampling, efficacy, and safety of POP.
  
  
  RESULTS
  During the study period, 79 patients who underwent POP for the evaluation of pancreatic stricture or dilatation were identified. Technical success was achieved in 78 (97%). In the PD neoplasia group (n = 33), the final diagnosis was based on index confirmatory POP-guided tissue sampling in 29 (88%). For the detection of PD neoplasia, POP visual impression had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 87%, 86%, 83%, 91%, and 87%, respectively. When combined with POP-guided tissue sampling, the values were 91%, 95%, 94%, 93%, and 94%, respectively. Of 102 POPs performed, adverse events were noted in 12 (12%) cases.
  
  
  CONCLUSIONS
  This study demonstrates a high technical success rate, visual impression accuracy, and tissue sampling capability of POP. Examinations were performed by endoscopists with expertise in pancreatoscopy interpretation, and the results may not be generalizable.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA; Division of Gastroenterology, Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Ihab I
authors.initials: II
authors.lastname: El Hajj
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Brauer
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA; Division of Gastroenterology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: Augustin R
authors.initials: AR
authors.lastname: Attwell
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014481:United States