Single-operator peroral pancreatoscopy in the preoperative diagnostics of suspected main duct intraductal papillary mucinous neoplasms: efficacy and novel insights on complications

Sini Vehviläinen; Niklas Fagerström; Roberto Valente; Hanna Seppänen; Marianne Udd; Outi Lindström; Harri Mustonen; Fredrik Swahn; Urban Arnelo; Leena Kylänpää

doi:10.1007/s00464-022-09156-3

Single-operator peroral pancreatoscopy in the preoperative diagnostics of suspected main duct intraductal papillary mucinous neoplasms: efficacy and novel insights on complications

Surg Endosc. 2022 Oct;36(10):7431-7443. doi: 10.1007/s00464-022-09156-3. Epub 2022 Mar 11.

Authors

Sini Vehviläinen^{1

2}, Niklas Fagerström³, Roberto Valente^{4

5}, Hanna Seppänen^{1

2}, Marianne Udd^{1

2}, Outi Lindström^{1

2}, Harri Mustonen^{1

2}, Fredrik Swahn⁶, Urban Arnelo^{7

8}, Leena Kylänpää^{1

2}

Affiliations

¹ Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.
² Translational Cancer Medicine Research Program, University of Helsinki, Helsinki, Finland.
³ Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁴ Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
⁵ Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 90185, Umeå, Sweden.
⁶ Department of Surgery, Skåne University Hospital, Lund, Sweden.
⁷ Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. urban.arnelo@regionvasterbotten.se.
⁸ Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 90185, Umeå, Sweden. urban.arnelo@regionvasterbotten.se.

Abstract

Background: Distinguishing intraductal papillary mucinous neoplasms (IPMNs) from other pancreatic cystic lesions is essential since IPMNs carry the risk of becoming malignant. Differentiating the main pancreatic duct involving IPMNs (MD-IPMNs) through conventional imaging is deficient. Single-operator peroral pancreatoscopy (SOPP) represents a promising method offering additional information on suspected lesions in the pancreatic main duct (MD). We aimed to determine the role of SOPP in the preoperative diagnostics of suspected MD-IPMNs and identify factors contributing to SOPP-related complications.

Materials and methods: In this primarily retrospective study, SOPPs were performed at three high-volume centers on suspected MD-IPMNs. Primary outcome was the clinical impact of SOPP to subsequent patient care. Additionally, we documented post-SOPP complications and analyzed several assumed patient- and procedure-related risk factors.

Results: One hundred and one (101) SOPPs were performed. Subsequent clinical management was affected due to the findings in 86 (85%) cases. Surgery was planned for 29 (29%) patients. A condition other than IPMN explaining MD dilatation was found in 28 (28%) cases. In 35 (35%) cases, follow-up with MRI was continued. Post-SOPP pancreatitis occurred in 20 (20%) patients and one of them was fatal. A decrease in odds of post-SOPP pancreatitis was seen as the MD diameter increases (OR 0.714 for 1.0 mm increase in MD diameter, CI 95% 0.514-0.993, p = 0.045). Furthermore, a correlation between lower MD diameter values and higher severity post-SOPP pancreatitis was seen (T_JT = 599, SE = 116.6, z = - 2.31; p = 0.020). History of pancreatitis after endoscopic retrograde cholangiopancreatography was a confirmed risk factor for post-SOPP pancreatitis. Conclusions between complications and other risk factors could not be drawn.

Conclusion: SOPP aids clinical decision-making in suspected MD-IPMNs. Risk for post-SOPP pancreatitis is not negligible compared to non-invasive imaging methods. The risk for pancreatitis decreases as the diameter of the MD increases.

Keywords: IPMN; Pancreatitis; Post-ERCP pancreatitis; Single-operator pancreatoscopy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma, Mucinous* / pathology
Carcinoma, Pancreatic Ductal* / surgery
Humans
Pancreatic Ducts / diagnostic imaging
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Pancreatitis* / pathology
Retrospective Studies