Post written by Yuki Tanisaka, MD, PhD, from the Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

Our patient was a 79-year-old man in whom computed tomography indicated expansion of the main pancreatic duct. Endoscopic ultrasound (EUS) showed expansion of the entire pancreatic duct but could not detect the villous protrusions. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for a more detailed exploration of the suspected IPMN. Endoscopic findings revealed dilation of the pancreatic duct orifice and mucus discharge. Pancreatography revealed defect of the inside of the main pancreatic duct. POPS (SPYGlass DS; Boston Scientific Corp.) detected villous protrusions on the inside of the main pancreatic duct. POPS-guided fluorescein-dripping CLE was performed using a probe-based device (pCLE; CholangioFlex, Cellvizio; Mauna Kea Technologies). Here, neoplastic tissue was visible as a dark, regularly arranged papillary structure. This finding did not indicate invasive carcinoma. In this case, the pCLE image and histology yielded similar sizes of the neoplastic papillae (120–140 μm) and degree of malignancy.

Although additional patient data must be accumulated, we think that the in vivo diagnosis of IPMN with POPS-guided pCLE may be useful for evaluating the degree of malignancy. And to our knowledge, this is the first report on this subject.

If the main pancreatic duct is dilated, and suspected IPMN, difficult to diagnose, POPS-guided pCLE may be useful for evaluating the degree of malignancy.

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