The usefulness of pancreatoscopic examination in patients with mucinous ductal ectasia

Abstract

Background: Mucinous ductal ectasia (MDE) is an uncommon disorder characterized by dilatation and filling of the main pancreatic duct or its side branches with viscid mucus and duodenoscopic findings often showing a patulous duodenal papilla extruding mucus. This study evaluates the usefulness of pancreatoscopic examination in patients with MDE. Methods : In 5 patients with MDE, pancreatoscopic examination was performed using ultrathin pancreatoscope (Fujikura FVS-3000, M & M Co., Tokyo, Japan) (n=4) and mother-babyscope (Olympus TJF M20 & CHF B20, Olympus, America Inc) (n=1) during endoscopic retrograde cholangiopancreatography. Results : 1) The mean age was 69 years (±9 : SD) and sex ratio was 3:2 (M:F). 2) The main lesions were located at the uncinate process of the pancre as head (n=3), the neck portion (n=1) and entire main pancreatic duct (n=1) 3) Histological findings showed hyperplasia in 2 patients, adenoma in 1 patient and adenocarcinoma in 2 patients. 4) Upon pancreatoscopic examination, multiple papillary or numerous villous projections of hyperplastic mucosa and frog-egg like mucosa covered with whitish mucus were noted in all patients. 5) In all patients examined by pancreatoscopy, the extent of pathology could be evaluated and we could confirm it by resected surgical specimens. Conclusions : Papillary or villous mucosal projections with viscid mucin may be characteristic findings of MDE. The pancreatoscopic examination in patients with MDE may give valuable informations in the differential diagnosis of amorphous filling defects in the pancreatic duct and in determining the extent of pathology.