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Surgical Endoscopy

, Volume 26, Issue 12, pp 3682–3685 | Cite as

Intraoperative pancreatoscopy with narrow band imaging: a novel method for assessment of resection margins in case of intraductal papillary mucinous neoplasm

  • Arun YelamaliEmail author
  • Magnus Jayaraj Mansard
  • Rohit Dama
  • Pradeep Rebela
  • Guduru Venkat Rao
  • Duvvuru Nageshwar Reddy
Dynamic Manuscript

Abstract

Background

Intraductal papillary mucinous neoplasm (IPMN) is characterized by intraductal proliferation of neoplastic mucinous cells with a variable extent along the main duct or its branches. The lesion may be continuous or discontinuous. Skip lesions have been described in about 6–19 % of cases. Complete resection without leaving behind any skip lesions is important, to such an extent that many groups suggest even total pancreatectomy, a major and morbid surgery.

Methods

A 40 year-male patient with chronic pancreatitis presented with recent-onset diabetes mellitus and weight loss. Ultrasound and computed tomography (CT) scan showed a cystic lesion in the head and uncinate process of pancreas. Peroral pancreatoscopy showed villous projections with dilated tortuous vessel in the head, suspicious of IPMN. The duct beyond pancreatic head could not be visualized and remained unassessed. At pancreatoduodenectomy, pancreatoscopy with narrow band imaging (NBI) was done using flexible pancreatoscope through the cut end of the duct at the neck to assess the duct in the body and tail.

Results

Pancreatoscopy with NBI showed a normal-looking resection margin and a skip lesion 1 cm beyond it. The revised resection margin confirmed the skip lesion on frozen section and also that the fresh cut margin was negative. The remaining duct in the body and tail was normal on pancreatoscopy. Total clearance of the disease could be achieved without a major procedure such as total pancreatectomy.

Conclusions

Intraoperative pancreatoscopy, especially with NBI, is a good diagnostic tool for IPMN and also helps in intraoperative decision-making of the resection margins.

Keywords

Pancreatic Duct Resection Margin Main Pancreatic Duct Intraductal Papillary Mucinous Neoplasm Narrow Band Imaging 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

Disclosures

Dr. Arun Yelamali, Dr. Magnus Jayaraj Mansard, Dr. Rohit Dama, Dr. Pradeep Rebela, Dr. Guduru Venkat Rao, and Dr. Duvvuru Nageshwar Reddy have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 30576 kb)

Supplementary material 2 (MPG 32868 kb)

References

  1. 1.
    Andrejevic-Blant S, Kosmahl M, Sipos B, Klöppel G (2007) Pancreatic intraductal papillary-mucinous neoplasms: a new and evolving entity. Virchows Arch 451:863–869PubMedCrossRefGoogle Scholar
  2. 2.
    Alain S, Anne C, Jacques B (2010) Role of frozen section assessment for intraductal papillary and mucinous tumor of the pancreas. World J Gastrointest Surg 2(10):352–358Google Scholar
  3. 3.
    Hidetoshi E, Osamu I, Hiroaki O, Sasaki Yo, Terumasa Y, Akihiko N, Hiroyuki U, Akemi T, Tsutomu K, Shingi I (2006) Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer 107:2567–2575CrossRefGoogle Scholar
  4. 4.
    Lai ECH, Lau WY (2005) Intraductal papillary mucinous neoplasms of the pancreas. Surgeon 3(5):317–324PubMedCrossRefGoogle Scholar
  5. 5.
    Sakorafas GH, Sarr MG (2007) Primary cystic neoplasms of the pancreas. In: Yeo CJ, Dempsey DT, Klein AS, Pemberton JH, Peters JH (eds) Shackelford’s surgery of the alimentary tract, 6th edn. Saunders Elsevier, Philadelphia, pp 1387–1399Google Scholar
  6. 6.
    Kaneko Tetsuya, Nakao Akimasa, Nomoto Shuji, Furukawa Tsuyoshi, Hirooka Yoshiki, Nakashima Nobuo, Nagasaka Tetsuro (1998) Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 133:263–267PubMedCrossRefGoogle Scholar
  7. 7.
    Song LM, Adler DG, Conway JD (2008) Narrow band imaging and multiband imaging, ASGE Technology Committee. Gastrointest Endosc 67:581–589PubMedCrossRefGoogle Scholar
  8. 8.
    Yoshifumi A, Daisuke M, Ken K, Katsuhiko M, Ken-Ichi K (2007) Peroral pancreatoscopy: current status and future expectations using narrow band imaging. Dig Endosc 19:79–86CrossRefGoogle Scholar
  9. 9.
    Yoshinori I, Tomihiro M, Naoki O, Ken I, Kazumasa M (2007) Endoscopic diagnosis of intraductal papillary mucinous neoplasm using peroral pancreatoscopy with narrow band imaging. Dig Endosc 19:105–108CrossRefGoogle Scholar
  10. 10.
    Akihiro I, Yoshiki H, Hiroki K, Yasumasa N, Hidemi G (2007) Endoscopic approach to the pancreatobiliary tract using narrow band imaging. Dig Endosc 19:115–120CrossRefGoogle Scholar
  11. 11.
    Tomihiro M, Yoshinori I, Naoki O, Kazumasa M, Yoichiro O (2010) Endoscopic diagnosis of intraductal papillary/mucinous neoplasm of the pancreas by means of peroral pancreatoscopy using a small/diameter videoscope and narrow/band imaging. Dig Endosc 22:119–123CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Arun Yelamali
    • 1
    Email author
  • Magnus Jayaraj Mansard
    • 1
  • Rohit Dama
    • 1
  • Pradeep Rebela
    • 1
  • Guduru Venkat Rao
    • 1
  • Duvvuru Nageshwar Reddy
    • 2
  1. 1.Department of Surgical GastroenterologyAsian Institute of GastroenterologyHyderabadIndia
  2. 2.Department of Medical GastroenterologyAsian Institute of GastroenterologyHyderabadIndia

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