Direct Pancreatoscopy

Abstract

Several imaging procedures, including transabdominal and endoscopic ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP), have been established for the diagnosis of pancreatic diseases. Among them, ERCP is the current gold standard for diagnosis of pancreatic cancer as well as other diseases involving the pancreatic duct. However, it may fail to differentiate strictures or intraluminal filling defects of the pancreatic duct. It may also fail to detect minimal change, and chronic pancreatitis may not be well visualized with contrast medium. Given these limitations, it is necessary to have a modality with a direct approach to the pancreatic duct. Based on this concept, Japanese endoscopists, including Takekoshi et al. [1], first developed peroral pancreatoscopy through the accessory channel of a duodenal fiberscope in 1975. However, this device proved unpopular in clinical use because of problems which included instrument expense, fragility, low visibility, and its relatively large diameter relative to the duodenal papilla.