Role of pancreatoscopy in the management of suspected and confirmed intraductal papillary mucinous neoplasm of the pancreas

Abstract

Intraductal papillary mucinous neoplasms (IPMN) are pre-malignant tumours of the pancreas with variable malignant potential. Imaging often fails to map the disease extent accurately and guidelines differ on surgical thresholds. Pancreatoscopy, providing direct visualisation of the pancreatic duct and the option of targeted biopsies, may be able to delineate disease boundaries and improve preoperative and intraoperative decision-making. This mini-review appraises the current role, evidence base, and technical application of pancreatoscopy in the management of suspected or confirmed IPMN, with particular focus on its impact on the extent of pancreatic resections. Reported data show detection of additional lesions in about 20%-40% of cases and changes to operative strategy in roughly one third of patients, with low complication rates and high concordance between visual features and histology. Limitations include restricted availability, learning requirements, heterogeneity of technique, absence of a standardised visual classification, and a paucity of prospective outcome data; current international guidelines remain cautious. Pancreatoscopy is a promising adjunct to refine patient selection and the extent of resection in IPMN, particularly for delineating ductal spread and guiding margins. Routine adoption will require robust prospective studies to define diagnostic accuracy, impact on recurrence and survival, and cost-effectiveness.