[Pancreaticoscopy: experiences, possibilities and limits].

Abstract

Cholangioscopy in the mother-baby technique is well accepted and widespread these days. On the other hand, the peroral pancreaticoscopy (POPS) is still in the initial phase of development. In cases of doubtful stenoses, duct discontinuation, and radiolucent shadows during an endoscopic retrograde cholangiopancreatography (ERCP) the POPS can be carried out as a clarifying examination. Two variations of babyscopes are currently available. The ultra-thin endoscope allows only limited results due to the lack of tip control and irrigation. On the other hand, devices with an outer diameter of 3.2 mm and larger provide for a sufficient assessment of the duct mucosa. Biopsies can be taken through the working channel, and the probes for intracorporeal shock wave lithotripsy (ISWL) can be placed under visual control. We performed POPS on 9 patients with an average age of 60 years using a tip-controlled endoscope. In 8 of these cases a diagnostic or therapeutic advantage was gained. A 29-year old patient with alcohol-induced chronic pancreatitis and an occluding duct stone underwent electrohydraulic lithotrips (EHL). A 60-year-old patient with pancreatic duct stones underwent laser-induced shock wave lithotripsy (LISL) in 2 sessions. Afterwards remaining parts of the calculi were extracted. The importance of this method in diagnosis and therapy of pancreatic diseases remains to be established, as evaluation studies of any great extent are still to be done.