Role of pancreatoscopy in management of pancreatic disease: A systematic review

Table 1 Per oral pancreatoscopy-guided pancreatic ductal stone therapy

Year	Ref.	Patients, n	Design	Device	EHL/LL	Success rate	AE %	Follow-up in mo
1999	Howell et al[14]	6	R/M	M-B	EHL	83	0	6
2009	Fishman et al[51]	6	R/M	Spyglass®	EHL	50	0	NA
2011	2Maydeo et al[21]	4	P/S	Spyglass®	LL	100	13.3	1
2013	Alatawi et al[12]	5	P/S	Spyglass®	LL	80%	0	21
2014	Attwel et al[19]	46	R/S	Olympus M-B (31) vs Spyglass® (15)	LL/EHL1	68 vs 73 (scope type)	10	18
2014	Ito et al[23]	8	R/S	Spyglass®	EHL1	37.5	25	NA
2015	Attwell et al[9]	28	R/M	Spyglass®	LL1	79	29	13
2016	2Navaneethan et al[52]	5	R/M	Spyglass®	LL	80	0	NA
2017	Bekkali et al[53]	6	R/S	Spyglass®	EHL	83	0	30
2017	Parbhu et al[22]	20	R/M	Spyglass®	EHL/LL	85	7.3	NA

¹Combined with ESWL.

²Combined study of patients with biliary and pancreatic ductal stones.

EHL: Electro hydraulic lithotripsy; LL: Laser lithotripsy; P: Prospective; R: Retrospective; S: Single-center; M: Multicenter; AE: Adverse events; M-B: Mother baby.

Table 2 Role of per oral pancreatoscopy in pancreatic ductal neoplasia

Year	Ref.	N	Design	Key findings	Adjunct modalities/success	AE%	Follow up
1997	Uehara et al[42]	11	P	Made early diagnosis of CIS missed by other modalities	Cytology in all (with secretin)	NR	34 mo
1998	Jung et al[39]	18	P	Visual differentiation - IPMN, Cancer, Chr pancreatitis	Cytology in all	6	2 yr
1998	Mukai et al[47]	25	R/S	Papillary lesions > 3 mm, trend towards malignancy	IDUS (> sensitive than POP) for detecting protrusions > 3 mm	4	NA
1998	Tajiri et al[54]	52	P	Visual intraductal findings to differentiate Chr pancreatitis and neoplaisa	81% success	3.8	NA
2000	Yamaguchi et al[27]	41	R/S	Villious/vegetative lesions with red marks correlate with atypical adenoma/cancer	73.2% success	NA	38.5 mo
2002	Kodama et al[37]	42	P	POP correctly identified all stenosis due to Chr pancreatitis	75% success	1.8	NA
2002	Hara et al[33]	60	R/S	POP + IDUS 88% accuracy in differentiating benign vs malignant POP better for MD type, IDUS better for SB type	IDUS in 40 patients Cytology in 36 patients - Low Sens 13%	7	38.4 mo
2003	Yamao et al[41]	115	R	Protrusion, friability 100% spec for malignant stenosis	83% success (lower for pancreatic tumor > 2 cm)	12	2 yr
2005	Yamaguchi et al[43]	103	R/S	Cytology has better diagnostic value when collected by POP vs catheter Better for MD type vs SB type	Cytology in 32 with POP, 71 via catheter	NR	18 mo
2005	Yasuda et al[36]	26	R	IDUS 100% Sens for lesions > 3 mm, POP Sens 67% No carcinoma in protrusions < 3 mm Biopsy Sens 50% for cancer	IDUS	0	NA
2010	Miura et al[48]	21	R/S	Protrusions and vascular patterns seen better with NBI as compared to white light	Narrow Band imaging (NBI) Technical success 90%	0	2 yr
2014	Arnelo et al[34]	44	P/S	Spyglass Sens 84%, spec 75% Acc for MD type 76% Acc for BD type 78%	Obtained - Brushings in 88% Biopsy in 41%	17	2.3 yr
2014	Nagayoshi et al[35]	17	R/S	Sens for detecting malignancy Irrigation Cytology Sens 100% Biopsy Sens 25%	Cytology	35 - mild	18.8 mo
2017	Parbhu et al[22]	16	R/M	Accuracy Biopsy 63.7% Biopsy + Visual 100%	Technical success for biopsy 100%	7.3	6 mo
2017	El Hajj et al[38]	79	R/S	Accuracy Visual 87% Visual + tissue 94% (combination)	Technical success 97% Tissue acquisition was combination of brushings, POP assisted and POP directed biopsy	12	12 mo (minimum)

POP: Per oral pancreatoscopy; IDUS: Intraductal ultrasound; P: Prospective; R: Retrospective; S: Single-center; M: Multicenter; AE: Adverse events; CIS: Carcinoma in situ; MD: Main duct; SB: Side branch; Sens: Sensitivity; Spec: Specificity; Acc: Accuracy.

Table 3 Per oral pancreatoscopy visual findings for pancreatic ductal abnormalities

	IPMN	Adenocarcinoma	Chronic pancreatitis
Uehara et al[42]	Papillary projections, irregular/nodular mucosa
Jung et al[39]	Papillary projections; Villous protrusions	Tumor vessels; Erosions	Smooth narrowing; White/gray mucosa; Blurred blood vessels
Tajiri et al[54]	Papillary projections; Salmon eggs	Protrusions; Tumor vessels; Friability, erosions	Protein plugs/stones; Edema, erythema, scar
Yamaguchi et al[27]	(1) Hyperplasia/Mild atypia; sessile or semi pedunculated with white color markings; (2) Severe atypia/adenocarcinoma semi pedunculated or villous or vegetative with red color markings
Kodama et al[37]	Papillary projections; Nodular/villous; White/spotty/red marks	Duct cut off; Friability/erosions	Stones, proteins plugs; Scar, erythema; Blurred vessels
Hara et al[33]	CIS/Invasive carcinoma; salmon eggs with vascular pattern; Villous/vegetative protrusions
Yamao et al[41]	Coarse, granular papillary projections with mucus	Papillary projection with tumor vessels; Protrusion/friability	Coarse erythema
Miura et al[48]	(1) High risk - villous/vegetative with tumor vessel; (2) Low risk - sessile / semi pedunculated
El Hajj et al[38]	(1) Invasive - villous/vegetative papillary projections; (2) Noninvasive - granular projections with erythema	Protrusion with tumor vessel; Ulceration; Infiltrative stricture	Coarse, blurred vessels, scarring, erythema and edema