Clinical application of the peroral electronic pancreatoscope for the investigation of intraductal mucin-hypersecreting neoplasm☆☆☆

Intraductal mucin-hypersecreting neoplasm is a premalignant or malignant tumor of the pancreas.1-4 Although many imaging modalities have been used to evaluate this entity, peroral pancreatoscopy, which allows direct observation of the pancreatic duct, has some advantages in the management of this disorder. Our recent development of the smallest known electronic endoscope, the peroral electronic pancreatoscope (PEPS), has allowed us to obtain extremely fine images of the pancreatic duct.5 In the present study, the pancreatic ducts in three cases with intraductal mucin-hypersecreting neoplasms were examined with the PEPS. The usefulness of the PEPS in the management of this neoplasm is discussed. The PEPS was developed with a newly designed 50,000-pixel interline charge-coupled device (CCD), about 1 mm square in size (Matsushita Electronics Corp., Osaka, Japan), in cooperation with Olympus Optical Co. (Tokyo, Japan). The PEPS has a 2.1 mm external diameter, and a forward viewing optical system with a field of view of 80 degrees and a depth of field of 1 to 30 mm. It has bidirectional tip deflection (up 120 degrees, down 120 degrees) but no accessory channel. The PEPS system was constructed to incorporate this endoscope, a processor modified from the CV-140 processor (Olympus Co.), and a color television display. The PEPS images are almost equal in quality to those of standard video endoscope systems. It offers a direct electronic image of the pancreatic duct that is fundamentally different from a fiberoptic pancreatoscope system equipped with a video converter. The procedure involves peroral transpapillary insertion of the pancreatoscope into the pancreatic duct through the accessory channel of a duodenoscope (JF-240, Olympus). The study protocol conformed with the Helsinki Declaration and was approved by the ethics committee of our university. Informed consent was obtained from all patients.