Although peroral pancreatoscopy (POPS) has been developed for detailed visualization of intraductal lesions, the images obtained are often inadequate because of the difficulty of insertion, the proximity of the pancreatoscope to the lesion, or visualization challenges due to mucus. Performance can be improved when it is combined with intraductal ultrasonography (IDUS) [1], narrow-band imaging (NBI) [2], and probe-based confocal laser endomicroscopy (pCLE) [3]; however, POPS alone has not achieved high quality intraductal imaging and is still under development.

Here, we report for the first time the use of an ultrathin endoscope with a transparent hood at the tip (Nichendo; Fujifilm Co., Tokyo, Japan) in POPS. This technique has been used in endoscopic submucosal dissection [4]; however, its use in the pancreaticobiliary region has not been reported.

A man in his 80s underwent follow-up magnetic resonance cholangiopancreatography (MRCP) for a branch duct intraductal papillary mucinous neoplasm (BD-IPMN); a fistula between the pancreatic duct branch and the stomach was suspected, with gastric perforation of the BD-IPMN ([Fig. 1]). To obtain a definitive diagnosis, we initially attempted visualization with a conventional endoscope (GIF-H290Z; Olympus, Tokyo, Japan); however, insertion was difficult ([Fig. 2]). Therefore, an ultrathin endoscope (GIF-XP260N; Olympus) with a transparent hood was used ([Fig. 3], [Video 1]).

This method enabled visualization of the pancreatic duct and its branches. White-light endoscopy (WLE) and NBI allowed visualization of the mucosa with high quality images and suggested a relationship between the mucosal appearance and atypical tissue ([Fig. 4]). Characteristic findings including a “bleached coral-like appearance”, indicating rough mucosa, “jellyfish-like appearance” at the entrance of the pancreatic branch duct, and “anemone-like appearance” near the gastrostomy were seen ([Fig. 5]).

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Article published online:
30 October 2024

© 2024. The Author(s). This article was originally published by Thieme in Endoscopy 2024; 56: E560–E562 as an open access article under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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