Usefulness of pancreatoscopy and EUS for intraductal papillary mucinous tumors of the pancreas

Intraductal papillary mucinous tumor (IPMT) is an uncommon tumor of the pancreas, which has been increasingly recognized recently and is important to diagnose because of its malignant potential and good survival if resected early. AIM: We reviewed our experience with this tumor, with particular emphasis on the usefulness of EUS and pancreatoscopy for diagnosis and management. METHODS: The clinical, endoscopic and pathologic records of 9 patients seen at our institution between 1994-96 were reviewed. RESULTS: There were 5 males and 4 females with a mean age of 63 years (range 39-85). The typical presentation was abdominal pain (89%), weight loss (78%), and hyperamylasemia (75%). The classical endoscopic appearance of a dilated papilla exuding mucin was seen in 8 (89%) patients. A dilated pancreatic duct (PD) with filling defects was present in all the patients. A pancreatic-biliary fistula was found in two patients. Pancreatoscopy with the Olympus XCHF BP30 prototype miniscope was performed in 5 of 9 patients. 3 patients had diffuse main PD involvement with typical "anemone"-like tumor fronds; one had focal involvement and another had a dilated main PD with large ectatic side-branches. In all 5 patients, pancreatoscopy assisted in delineating the extent of involvement which helped to determine the extent of surgical excision. Endosonography (EUS) was performed in 8 patients, with the findings of dilated PD in 7 patients, dilated side-branches in 5 and mass lesion in three. 7 of 9 patients had surgical resection, with pathology showing intraductal papillary mucin-producing neoplasm. Carcinomatous transformation had occurred in one patient, while dysplastic changes were present in the rest. CONCLUSION: Pancreatoscopy was useful in confirming the diagnosis, determining the extent of involvement and thereby helped in the planning of surgery. EUS correctly diagnosed PD dilatation or a mass lesion in all patients.