Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both...Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.展开更多
AIM: To provide consensus statements on the use of per-oral cholangiopancreatoscopy(POCPS).METHODS: A workgroup of experts in endoscopic retrograde cholangiopancreatography(ERCP), endosonography, and POCPS generated c...AIM: To provide consensus statements on the use of per-oral cholangiopancreatoscopy(POCPS).METHODS: A workgroup of experts in endoscopic retrograde cholangiopancreatography(ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review.RESULTS: Six consensus statements were generated:(1) POCPS is now an important additional tool during ERCP;(2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis;(3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail;(4) in patients with main duct intraductal papillary mucinous neoplasms(IPMN) POPS may be used to assess extent of tumor to assist surgicalresection;(5) in difficult pancreatic ductal stones,POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and(6) additional indications for POCPS include selective guidewire placement,unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents. CONCLUSION: POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for preoperative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusua indications involving selective guidewire placement,assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.展开更多
Per-oral pancreatoscopy(POPS)is an endoscopic procedure to visualize the main pancreatic duct.POPS specifically has the advantage of direct visualization of the pancreatic duct,allowing tissue acquisition and directed...Per-oral pancreatoscopy(POPS)is an endoscopic procedure to visualize the main pancreatic duct.POPS specifically has the advantage of direct visualization of the pancreatic duct,allowing tissue acquisition and directed therapies such as stones lithotripsy.The aim of this review is to analyze and summarize the literature around pancreatoscopy.Pancreatoscopy consists of the classic technique of the mother-baby method in which a mini-endoscope is passed through the accessory channel of the therapeutic duodenoscope.Pancreatoscopy has two primary indications for diagnostic purpose.First,it is used for visualization and histological diagnosis of intraductal papillary mucinous neoplasms.In these cases,POPS is very useful to assess the extent of malignancy and for the study of the intraductal papillary mucinous neoplasm in order to guide the surgery resection margins.Second,it is used to determine pancreatic duct strictures,particularly important in cases of chronic pancreatitis,which is associated with both benign and malignant strictures.Therefore POPS allows differentiation between benign and malignant disease and allows mapping the extent of the tumor prior to surgical resection.Also tissue sampling is possible,but it can be technically difficult because of the limited maneuverability of the biopsy forceps in the pancreatic ducts.Pancreatoscopy can also be used for therapeutic purposes,such as pancreatoscopy-guided lithotripsy in chronic painful pancreatitis with pancreatic duct stones.The available data for the moment suggests that,in selected patients,pancreatoscopy has an important and promising role to play in the diagnosis of indeterminate pancreatic duct strictures and the mapping of main pancreatic duct intraductal papillary mucinous neoplasms.However,further studies are necessary to elucidate and validate the pancreatoscopy role in the therapeutic algorithm of chronic pancreatitis.展开更多
BACKGROUND Per-oral pancreatoscopy(POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIM To evaluate the effica...BACKGROUND Per-oral pancreatoscopy(POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid.Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound(IDUS) and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures, multiple stonesand the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.展开更多
AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prosp...AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4%(8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate.展开更多
Pancreatoscopy plays a significant role in the diagnosis and treatment of pancreatic diseases.However,the risk of pancreatoscopy is remarkably greater than that of other endoscopic procedures,such as gastroscopy and b...Pancreatoscopy plays a significant role in the diagnosis and treatment of pancreatic diseases.However,the risk of pancreatoscopy is remarkably greater than that of other endoscopic procedures,such as gastroscopy and bronchoscopy,owing to its severe invasiveness.In comparison,virtual pancreatoscopy(VP)has shown notable advantages.However,because of the low resolution of current computed tomography(CT)technology and the small diameter of the pancreatic duct,VP has limited clinical use.In this study,an optimal path algorithm and super-resolution technique are investigated for the development of an open-source software platform for VP based on 3D Slicer.The proposed segmentation of the pancreatic duct from the abdominal CT images reached an average Dice coefficient of 0.85 with a standard deviation of 0.04.Owing to the excellent segmentation performance,a fly-through visualization of both the inside and outside of the duct was successfully reconstructed,thereby demonstrating the feasibility of VP.In addition,a quantitative analysis of the wall thickness and topology of the duct provides more insight into pancreatic diseases than a fly-through visualization.The entire VP system developed in this study is available at https://github.com/gaoyi/VirtualEndoscopy.git.展开更多
Peroral pancreatoscopy(POPS)is a demanding endoscopic procedure that can be used to perform intracanal lithotripsy in obstructing pancreatic stones but the experience is limited.Most stones can be removed successfully...Peroral pancreatoscopy(POPS)is a demanding endoscopic procedure that can be used to perform intracanal lithotripsy in obstructing pancreatic stones but the experience is limited.Most stones can be removed successfully by endoscopic retrograde cholangio-pancreatography but patients with large stones require advanced therapeutic approaches,such as extracorporeal shock wave lithotripsy(alone or followed by endoscopic retrograde cholangio-pancreatography),currently the mainstay of treatment.Unfortunately,in about 10%of cases,extracorporeal shock wave lithotripsy can fail;moreover,it is not be available in many institutions.For this subgroup of patients,POPS guided-lithotripsy can play a role and have benefits.The most consistent study concerns a retrospective multicenter analysis that enrolled few patients per center.Considering the epidemiological scenario and the scant volume of skilled endoscopists,POPS must be developed in very few high-volume referral centers with standardized pathways and capable of performing multi-modality treatment.In addition,we could reasonably assume that POPS-guided-lithotripsy should be used as rescue therapy in special situations,identifying the ideal candidate who can achieve the maximum clinical result,and carefully balancing risk/benefits ratio.展开更多
Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a br...Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.展开更多
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 "mothe...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. Intraductal endoscopy significantly increases 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.展开更多
Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrha...Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.展开更多
Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions.The proper diagnosis,differentiation,and staging of these cystic lesions are considered a cr...Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions.The proper diagnosis,differentiation,and staging of these cystic lesions are considered a crucial issue in planning further management.There are great challenges for their diagnostic models.In our time,new emerging methods for this diagnosis have been discovered.Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needlebased confocal laser endomicroscopy,through the needle microforceps biopsy,and single-operator cho-langioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions.Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.展开更多
文摘Pancreatoscopy is an advanced endoscopic technique that enables high-resolution imaging of the main pancreatic duct.Its relevance has grown in recent years with the introduction of novel technologies,allowing for both diagnosis and treatment within a single procedure.In therapeutic applications,it facilitates interventions such as stone fragmentation,stone retrieval,and tumor-related obstruction management.In diagnostic applications,it improves the accuracy of biopsies for suspicious lesions,particularly in cases of cystic neoplasms,indeterminate strictures,and pancreatic fistula assessments.The most common complications include postprocedural pancreatitis and self-limited abdominal pain,with their incidence mitigated by prophylactic anti-inflammatory drugs and pancreatic stent placement.Despite being limited by the need for specialized equipment and trained personnel,technological advancements may position pancreatoscopy as a first-line tool in modern clinical practice.
文摘AIM: To provide consensus statements on the use of per-oral cholangiopancreatoscopy(POCPS).METHODS: A workgroup of experts in endoscopic retrograde cholangiopancreatography(ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature review.RESULTS: Six consensus statements were generated:(1) POCPS is now an important additional tool during ERCP;(2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis;(3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail;(4) in patients with main duct intraductal papillary mucinous neoplasms(IPMN) POPS may be used to assess extent of tumor to assist surgicalresection;(5) in difficult pancreatic ductal stones,POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and(6) additional indications for POCPS include selective guidewire placement,unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents. CONCLUSION: POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for preoperative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusua indications involving selective guidewire placement,assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.
文摘Per-oral pancreatoscopy(POPS)is an endoscopic procedure to visualize the main pancreatic duct.POPS specifically has the advantage of direct visualization of the pancreatic duct,allowing tissue acquisition and directed therapies such as stones lithotripsy.The aim of this review is to analyze and summarize the literature around pancreatoscopy.Pancreatoscopy consists of the classic technique of the mother-baby method in which a mini-endoscope is passed through the accessory channel of the therapeutic duodenoscope.Pancreatoscopy has two primary indications for diagnostic purpose.First,it is used for visualization and histological diagnosis of intraductal papillary mucinous neoplasms.In these cases,POPS is very useful to assess the extent of malignancy and for the study of the intraductal papillary mucinous neoplasm in order to guide the surgery resection margins.Second,it is used to determine pancreatic duct strictures,particularly important in cases of chronic pancreatitis,which is associated with both benign and malignant strictures.Therefore POPS allows differentiation between benign and malignant disease and allows mapping the extent of the tumor prior to surgical resection.Also tissue sampling is possible,but it can be technically difficult because of the limited maneuverability of the biopsy forceps in the pancreatic ducts.Pancreatoscopy can also be used for therapeutic purposes,such as pancreatoscopy-guided lithotripsy in chronic painful pancreatitis with pancreatic duct stones.The available data for the moment suggests that,in selected patients,pancreatoscopy has an important and promising role to play in the diagnosis of indeterminate pancreatic duct strictures and the mapping of main pancreatic duct intraductal papillary mucinous neoplasms.However,further studies are necessary to elucidate and validate the pancreatoscopy role in the therapeutic algorithm of chronic pancreatitis.
文摘BACKGROUND Per-oral pancreatoscopy(POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid.Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound(IDUS) and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures, multiple stonesand the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease.
文摘AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4%(8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate.
基金This work is partially supported by the Key-Area Research and Development Program of Guangdong Province,No.2021B0101420005the Key Technology Development Program of Shenzhen,No.JSGG20210713091811036+4 种基金the Department of Education of Guangdong Province,No.2017KZDXM072the National Natural Science Foundation of China,No.61601302the Shenzhen Key Laboratory Foundation,No.ZDSYS20200811143757022the Shenzhen Peacock Plan,No.KQTD2016053112051497the SZU Top Ranking Project,No.86000000210.
文摘Pancreatoscopy plays a significant role in the diagnosis and treatment of pancreatic diseases.However,the risk of pancreatoscopy is remarkably greater than that of other endoscopic procedures,such as gastroscopy and bronchoscopy,owing to its severe invasiveness.In comparison,virtual pancreatoscopy(VP)has shown notable advantages.However,because of the low resolution of current computed tomography(CT)technology and the small diameter of the pancreatic duct,VP has limited clinical use.In this study,an optimal path algorithm and super-resolution technique are investigated for the development of an open-source software platform for VP based on 3D Slicer.The proposed segmentation of the pancreatic duct from the abdominal CT images reached an average Dice coefficient of 0.85 with a standard deviation of 0.04.Owing to the excellent segmentation performance,a fly-through visualization of both the inside and outside of the duct was successfully reconstructed,thereby demonstrating the feasibility of VP.In addition,a quantitative analysis of the wall thickness and topology of the duct provides more insight into pancreatic diseases than a fly-through visualization.The entire VP system developed in this study is available at https://github.com/gaoyi/VirtualEndoscopy.git.
文摘Peroral pancreatoscopy(POPS)is a demanding endoscopic procedure that can be used to perform intracanal lithotripsy in obstructing pancreatic stones but the experience is limited.Most stones can be removed successfully by endoscopic retrograde cholangio-pancreatography but patients with large stones require advanced therapeutic approaches,such as extracorporeal shock wave lithotripsy(alone or followed by endoscopic retrograde cholangio-pancreatography),currently the mainstay of treatment.Unfortunately,in about 10%of cases,extracorporeal shock wave lithotripsy can fail;moreover,it is not be available in many institutions.For this subgroup of patients,POPS guided-lithotripsy can play a role and have benefits.The most consistent study concerns a retrospective multicenter analysis that enrolled few patients per center.Considering the epidemiological scenario and the scant volume of skilled endoscopists,POPS must be developed in very few high-volume referral centers with standardized pathways and capable of performing multi-modality treatment.In addition,we could reasonably assume that POPS-guided-lithotripsy should be used as rescue therapy in special situations,identifying the ideal candidate who can achieve the maximum clinical result,and carefully balancing risk/benefits ratio.
文摘Pancreatic cystic lesions are being increasingly detected,mainly due to the widespread use of cross-sectional imaging.The reported prevalence ranges from 13%to 18%in asymptomatic individuals.These lesions display a broad histologic spectrum,from benign pseudocysts to premalignant mucinous cystic neoplasms and invasive carcinomas.Although many classification and management strategies exist,the natural history of numerous pancreatic cystic lesions remains incompletely understood,contributing to significant clinical uncertainty.Current diagnostic tools,including computed tomography,magnetic resonance imaging,endoscopic ultrasound,and cyst fluid analysis,are constrained by either suboptimal sensitivity or high costs.Cytology,while specific when positive,suffers from low sensitivity.Biochemical markers such as carcinoembryonic antigen,amylase,and glucose can help in cyst differentiation,whereas molecular testing(e.g.,KRAS,GNAS,RNF43 mutations)provides additional diagnostic and prognostic value.However,the application of molecular diagnostics is still restricted in routine practice due to costs,access issues,and a lack of standardization.This diagnostic uncertainty leads to both overtreatment and undertreatment.Some patients undergo unnecessary surgeries for benign lesions,which exposes them to procedural risks and long-term consequences.Others may experience delays in interventions for high-risk cysts and missing opportunities for cancer prevention.Additionally,prolonged,and often unnecessary surveillance burdens patients and healthcare systems psychologically and financially.In this minireview,we present a comprehensive overview of the classification,diagnostic approach,and management of pancreatic cystic lesions,incorporating recent evidence and current international guidelines(Fukuoka,American Gastroenterological Association,European).We also highlight the limitations of existing strategies and emerging tools such as radiomics,next-generation sequencing,and novel biomarkers.Additionally,we emphasize the urgent need for cost-effective,accurate,and accessible diagnostic pathways.A more refined risk stratification approach is essential to optimize outcomes,reduce healthcare waste,and improve the quality of life for patients with pancreatic cystic lesions.
文摘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. Intraductal endoscopy significantly increases 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.
文摘Hemosuccus pancreaticus is a rare cause of intermittent upper gastrointestinal bleeding. We report two cases of hemosuccus pancreaticus with multiple episodes of upper gastrointestinal bleeding. The causes of hemorrhage were rupture of pseudoaneurysm of the splenic artery and bleeding from the wall of pancreatic pseudocyst. Interventional radiology is the first modality for early diagnosis and possible treatment of hemosuccus pancreaticus. When angiography shows no abnormal findings or interventional radiological therapy can not be successful, surgery should be considered without delay. Our patients herein underwent surgery without recurrence or sequelae. Intraoperative ultrasonography and pancreatoscopy were helpful modalities for confirming the source of hemorrhage and determining the cutting line of the pancreas. When we encounter intermittent upper gastrointestinal bleeding with an obscure source, hemosuccus pancreaticus should be included in differential diagnoses especially in patients with chronic pancreatitis, which would lead to a prompt and proper treatment.
文摘Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions.The proper diagnosis,differentiation,and staging of these cystic lesions are considered a crucial issue in planning further management.There are great challenges for their diagnostic models.In our time,new emerging methods for this diagnosis have been discovered.Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needlebased confocal laser endomicroscopy,through the needle microforceps biopsy,and single-operator cho-langioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions.Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.
