title: Efficacy, Safety, and Outcomes of Endoscopic Retrograde Cholangiopancreatography With Per-Oral Pancreatoscopy: A Multicenter Experience.
abstract: BACKGROUND
  Per-oral pancreatoscopy can be used for both evaluation and treatment of pancreatic duct stones during endoscopic retrograde cholangiopancreatography, evaluating and treating pancreatic duct strictures of indeterminate etiology, and visual inspection and direct biopsy of pancreatic duct mucosa for diagnosis of intraductal papillary mucinous neoplasm (IPMN). We aim to describe the efficacy, safety, and outcomes of pancreatoscopy in a large, multicenter series of patients.
  
  
  METHODS
  A multicenter retrospective review was conducted of all patients who underwent per-oral pancreatoscopy at 2 large tertiary-care medical centers. Review of relevant medical records, laboratory data, imaging studies, endoscopic procedure notes, telephone follow-up notes, and progress notes was performed.
  
  
  RESULTS
  Thirty-three patients underwent 41 pancreatoscopy procedures. Indications included: 20 (48.8%) for diagnosis and treatment of pancreatic duct stones, 16 (39%) for investigation of IPMN, and 5 (12.2%) for evaluation of pancreatic duct strictures.In 20 procedures performed for stone disease, complete pancreatic duct clearance was achieved in 17 of 20 (85%) cases. Strictures were successfully dilated in 5 of 5 (100%) procedures. Direct visualization and biopsy demonstrated IPMN in 11 of 11 (100%) cases. Adverse events occurred in 3 of 41 (7.3%) of procedures, all of which were mild.
  
  
  CONCLUSIONS
  In this large series, we demonstrate that in patients with difficult to manage stone disease, strictures and possible malignant ductal pathology, pancreatoscopy is an effective and safe tool that can facilitate both diagnosis and effective therapy. Adverse events in our study were mild and within acceptable limits, further demonstrating that this is a safe procedure that should be offered to appropriate patients.
authors.affiliation: *Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT †Jefferson University School of Medicine, Gastroenterology and Hepatology, Philadelphia, PA.
authors.forename: Sheeva K
authors.initials: SK
authors.lastname: Parbhu
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Megan
authors.initials: M
authors.lastname: Murphy
authors.forename: Arish
authors.initials: A
authors.lastname: Noor
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Taylor
authors.forename: Alyssa
authors.initials: A
authors.lastname: Mills
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D012189:Retrospective Studies; D055815:Young Adult