The role of pancreatoscopy in the diagnostic work-up of intraductal papillary mucinous neoplasms: a systematic review and meta-analysis

Confirming the diagnosis, invasiveness, and disease extent of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is challenging. The aim of this study was to summarize the literature on the efficacy and safety of peroral pancreatoscopy (POP) in the diagnosis of IPMN, including the impa...

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Bibliographic Details
Published in:	Endoscopy Vol. 55; no. 1; p. 25
Main Authors:	de Jong, David M, Stassen, Pauline M C, Groot Koerkamp, Bas, Ellrichmann, Mark, Karagyozov, Petko I, Anderloni, Andrea, Kylänpää, Leena, Webster, George J M, van Driel, Lydi M J W, Bruno, Marco J, de Jonge, Pieter J F
Format:	Journal Article
Language:	English
Published:	Germany 01-01-2023
Subjects:	Carcinoma, Pancreatic Ductal - diagnosis Carcinoma, Pancreatic Ductal - pathology Carcinoma, Pancreatic Ductal - surgery Cholangiopancreatography, Endoscopic Retrograde - adverse effects Humans Neoplasms, Cystic, Mucinous, and Serous - pathology Pancreatic Ducts - surgery Pancreatic Intraductal Neoplasms - diagnostic imaging Pancreatic Intraductal Neoplasms - surgery Pancreatic Neoplasms - pathology Retrospective Studies
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Summary:	Confirming the diagnosis, invasiveness, and disease extent of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas is challenging. The aim of this study was to summarize the literature on the efficacy and safety of peroral pancreatoscopy (POP) in the diagnosis of IPMN, including the impact of pre- and intraoperative POP on the management of IPMN. The EMBASE, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar databases were systematically searched for articles. Eligible articles investigated cohorts of patients who underwent POP for (suspected) IPMN. 25 articles were identified and included in this review; with 22 of these reporting on the diagnostic yield of POP in IPMN and 11 reporting on the effect of pre- or intraoperative POP on clinical decision-making. Cannulation and observation rates, and overall diagnostic accuracy were high across all studies. Frequently reported visual characteristics of IPMN were intraductal fish-egg-like lesions, hypervascularity, and granular mucosa. Overall, the adverse event rate was 12 %, primarily consisting of post-endoscopic retrograde cholangiopancreatography pancreatitis, with a pooled rate of 10 %, mostly of mild severity. Regarding the impact of POP on clinical decision-making, POP findings altered the surgical approach in 13 %-62 % of patients. POP is technically successful in the vast majority of patients with (suspected) IPMN, has a consistently high diagnostic accuracy, but an adverse event rate of 12 %. Data on intraoperative pancreatoscopy are scarce, but small studies suggest its use can alter surgical management. Future studies are needed to better define the role of POP in the diagnostic work-up of IPMN.
ISSN:	1438-8812
DOI:	10.1055/a-1869-0180