Tu1423 DIGITAL PANCREATOSCOPY IN THE EVALUATION OF MAIN DUCT INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM: A MULTI-CENTER STUDY

Single operator digital pancreatoscopy has become commercially available. The aims of this study are to look at the outcomes of digital pancreatoscopy in main duct intraductal papillary mucinous neoplasms. This is a multi-center retrospective study. Outcomes analyzed were technical success, safety, incremental pathology yield compared to prior cross-sectional/echoendoscopic imaging, and utility (if the device changed surgical management). A total of 31 patients were enrolled from six tertiary care centers. Patient and procedure characteristics are listed in Table 1. Forty-two percent had a diffusely dilated duct while the rest had a focally dilated duct. Visual findings on pancreatoscopy were fronds/papillary projections (87%), a mass/nodule (32%), and fish-egg like protrusions (29%) (FIGURE 1). Technical success was achieved in 100% of cases (p< 0.001). Forty-two percent of cases had findings seen on pancreatoscopy that were not seen on cross-sectional imaging or EUS (p=0.21). Overall, digital pancreatoscopy dictated the type of surgery performed in 45% (13) of the cases that underwent surgery (p=0.6). However, when the patient had a diffusely dilated pancreatic duct greater than 10 mm, the pancreatoscopy dictated the type of surgery 77% of the time (10/13, p=0.007). Patients with a diffusely dilated duct were less likely to develop post-ERCP pancreatitis than those with a focally dilated duct. One patient out of 13 (8%) with a diffusely dilated duct developed PEP while 7 out of 18 (39%) patients with a focally dilated duct developed PEP (8% vs 39%; p=0.05). Digital pancreatoscopy should be considered in the diagnostic algorithm of main duct IPMN, especially for patients with a diffusely dilated pancreatic duct diameter of >10 mm, and without any focal lesions seen on cross-sectional imaging.Tabled 1TABLE 1: PATIENT AND PROCEDURE CHARACTERISTICSPATIENT CHARACTERISTICSFemale17 (55%)Median Age67Median Pancreatic Duct Diameter10 mmDiffusely Dilated Pancreatic Duct13 (42%)Fish mouth appearance of the pancreatic duct25 (81%)PROCEDURE CHARACTERISTICSDeep Cannulation Achieved31 (100%)Antibiotics Given31 (100%)Pancreatic Sphincterotomy Performed18 (58%)Pancreatic Duct Stent Placed18 (58%)Pancreatoscopy Scope Advanced To:Head/Neck of Pancreatic Duct17 (55%)Body/Tail of Pancreatic Duct14 (45%)Changes of IPMN Seen:Head/Neck21 (68%)Body/Tail6 (19%)Diffuse4 (13%)Pancreatoscopy Directed Biopsies Taken28 (90%)Pancreatoscopy Findings:Fronds/Papillary Projections27 (87%)Mass/Nodule10 (32%)Fish-egg like Protrusions9 (29%)Histology from Pancreatoscopy Directed Biopsies:IPMN with LGD22 (79%)IPMN with HGD5 (16%)IPMN with adenocarcinoma1 (4%) Open table in a new tab