Intraoperative Pancreatoscopy With the Ultrathin Pancreatoscope for Mucin-Producing Tumors of the Pancreas

Kaneko, Tetsuya; Nakao, Akimasa; Nomoto, Shuji; Furukawa, Tsuyoshi; Hirooka, Yoshiki; Nakashima, Naoki; Nagasaka, Tetsuro

doi:10.1001/archsurg.133.3.263

Cited by 85 publications

(62 citation statements)

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“…These authors also found that colloid carcinoma was a favorable prognostic factor independent of patient age, tumor diameter or disease stage. Lastly, debate around the concepts of a local field defect versus disease multicentricity further clouds our understanding of the exact biology of these lesions [13,14,[21][22][23][24][25][26] .…”

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confidence: 99%

“…In addition, all have relatively short mean follow-up periods (maximum 40 mo) further complicating the interpretation of a neoplasm with a known indolent course. Following operation, the risk of recurrence in either the remnant pancreas or distant sites is high (up to 65%) in patients with invasive IPMN [13,14,[21][22][23] . This rate is substantially lower (< 8%) in patients with noninvasive IPMN (adenoma, dysplasia, carcinoma in situ) [13,14,[21][22][23] .…”

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confidence: 99%

“…Following operation, the risk of recurrence in either the remnant pancreas or distant sites is high (up to 65%) in patients with invasive IPMN [13,14,[21][22][23] . This rate is substantially lower (< 8%) in patients with noninvasive IPMN (adenoma, dysplasia, carcinoma in situ) [13,14,[21][22][23] . In summary, the current literature regarding the natural history of IPMN is limited by selection bias (mostly resected patients), unclear definitions, varying inclusion criteria, heterogeneous patient groups, small nonoperative surveillance cohorts and relatively short follow-up periods [52,53] .…”

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confidence: 99%

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Natural history of intraductal papillary mucinous neoplasia: How much do we really know?

Ball

Howard

2010

WJGS

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Information on the natural history of intraductal papillary mucinous neoplasia (IPMN) is currently inadequate due to a lack of carefully orchestrated long-term followup on a large cohort of patients with asymptomatic disease. Based on the available data, one can draw the conclusions that main duct IPMN is commonly associated with malignancy and an aggressive operative stance should be taken with resection being offered to most patients who are suitable operative candidates. In contrast, the majority of branch type IPMN with a diameter of less than 3 cm can be safely followed with routine surveillance imaging provided they lack the high-risk covariates of age, symptomatology, nodularity or wall thickness. Natural history is defined as the "study of the natural development of a disease over a period of time" [1] . While this task for intraductal papillary mucinous neoplasm (IPMN) of the pancreas may seem straightforward, the recent recognition of IPMN as a distinct pathological entity coupled with its histopathological complexity makes this assignment exceedingly difficult. The initial description of IPMN was published in 1982 [2] . However, it was not until 1996 (further clarified in 2000) that the World Health Organization formally differentiated it from other mucin-producing cystic lesions of the pancreas through a uniform classification scheme [3,4] . With this consensus nomenclature came the realization that IPMN consists of a spectrum of neoplasms (subtypes include: gastric, intestinal, pancreatobiliary and oncocytic) which show both morphological and immunohistochemical variation [5] . It is currently unknown whether these four subtypes represent distinct pathological entities (with different biological potentials) or simply histological variations along a single progressive neoplastic lineage [6] . Confounding these distinctions is the ambiguity over the exact sequence of events and the precise time frame of histopathological lesion progression from noninvasive (adenoma, borderline tumor, carcinoma-in-situ) to invasive adenocarcinoma. Even with recent data supporting the concept of clonal progression in IPMN [7] , evidence substantiating a stepwise and orderly evolution by way of the adenoma to dysplasia 368 Online Submissions: http://www.wjgnet.com/1948-9366office wjgs@wjgnet.com

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Natural history of intraductal papillary mucinous neoplasia: How much do we really know?

Ball

Howard

2010

WJGS

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“…Because IPMN is characterised by multifocality, total pancreatectomy has been advocated [11] [31] [32]. Advocates of this policy argue on the basis that up to 30% of patients will have multifocality at the time of diagnosis [11] [33] [34]. Furthermore, achieving clear margins does not necessarily mean there would be no missed foci in the pancreatic tissue left behind in the context of a multifocal disease.…”

Section: Managementmentioning

confidence: 99%

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Elkak¹

2016

JCT

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Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours. The understanding of the pathology, clinical features, diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed database research was performed. Relevant articles published in English were identified and scrutinized. Duplications of information and persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be differentiated from pancreatic pseudocysts. Cystic tumours could be classified into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these tumours should be regarded, at least, as potentially malignant but they may be frankly malignant. The age of the patient and site of the lesion may be helpful in the diagnosis. In particular, MCN is always encountered in females in their middle age and often in the body and tail of the pancreas. Many of these tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be interpretted with caution as IPMN may present as pancreatitis. CT is the primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP have all been utilised. Biochemical markers are of limited value in the diagnosis. Conclusions: Management decision depends primarily on the understanding of pathology and on how confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation performed for most other tumours according to the location of the lesion which means that distal pancreatectomy is usually the operation performed for MCN. Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all been described in the literature. Laparoscopy is more suitable for benign or low grade malignant tumours in the context of distal pancreatectomy. Spleen should be preserved unless splenectomy is

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“…Thus, this study concluded that peroral pancreatoscopy and pancreatoscopic cytology are indeed useful for locating and diagnosing carcinoma in situ of the pancreas. In 1998, further evidence of the additive value of pancreatoscopy to supplement traditional diagnostic techniques was published [51] . In this report, pancreatoscopy was performed in 24 patients with intraductal mucinous neoplasms of the pancreas.…”

Section: Diagnostic Applicationsmentioning

confidence: 99%

Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility

Judah

Draganov²

2008

WJG

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Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts. For many years, technological challenges have made performing these procedures difficult. The "mother-baby" system and other various miniscopes have been developed, but routine use has been hampered due to complex setup, scope fragility and the time consuming, technically demanding nature of the procedure. Recently, the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options. The clinical utility of intraductal endoscopy is broad. It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue. Therapeutic interventions, such as electrohydraulic lithotripsy (EHL), laser lithotripsy, photodynamic therapy, and argon plasma coagulation (APC), may also be performed as part of intraductal endoscopy. I n t ra d u c t a l e n d o s c o p y s i g n i f i c a n t l y i n c r e a s e s the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP), and as technology progresses, it is likely that its utilization will only increase. In this review of intraductal endoscopy, we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.

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Intraoperative Pancreatoscopy With the Ultrathin Pancreatoscope for Mucin-Producing Tumors of the Pancreas

Cited by 85 publications

References 20 publications

Natural history of intraductal papillary mucinous neoplasia: How much do we really know?

Natural history of intraductal papillary mucinous neoplasia: How much do we really know?

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Intraductal biliary and pancreatic endoscopy: An expanding scope of possibility

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