Abstract
Findings of pancreatoscopy were reported in several kinds of pancreatic disease and compared with the pathological findings. A thin (3.2 mm in diameter), flexible fiberoptic endoscope with bending system (up 160°c, down 90°c) and an irrigation channel (0.5 mm in diameter) was used in this series. Pocedures of the pancreatoscopy were peroral pancreatoscopy (PPS) in 13 cases, intraoperative pancreatoscopy (TOPS) in 12 cases, pancreatoscopy of the resected specimens in 15 cases. In 10 cases of pancreas cancer (common type), pancreatoscopy revealed rough surface in 90%, reddness in 70%, proliferative changes in 70%, and dilatation of capillary vessels (capillary sign) in 60% at the stenosis of the pancreatic duct. Compared with the pancreatoscopic findings in 9 cases of chronic pancreatitis, the characteristic features of the pancreatoscopy in pancreas cancer were revealed proliferative changes and a capillary sign. Histologically, the proliferative changes were due to the cancer invasion to the pancreatic duct and capillary sign due to the hypervascularity in the pancreatic duct. In 4 cases of pancreas cancer (mucous producing type) and 3 cases of intraductal papilloma of the pancreas, pancreatoscopy showed the characteristic findings ; papillary lesions were observed in the pancreatic duct, looking like "frog's eggs", because they had a reddish center, which was ascertained the tumor vessels on histological examination. In the cases of cancer, papillary tumors were large and various in shape, but in the cases of adenoma, they were small and uniform. Pancreatoscopy (PPS and TOPS) is an useful method for not only the differential diagnosis of the pancreas cancer but also the diagnosis of the cancer extention to the main pancreatic duct.
