Post written by Kambiz Kadkhodayan, MD, from the Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.

Main duct—type intraductal pancreatic mucinous neoplasms (IPMNs) present a diagnostic and management challenge, requiring careful evaluation to accurately determine the extent of the disease and guide treatment decisions. Preoperative or intraoperative pancreatoscopy proves to be invaluable when assessing the extent of ductal involvement.

However, visualization of IPMNs can be challenging, especially in patients with pre-existing stents. Chromoendoscopy enhances mucosal visualization and diagnostic yield in the GI tract and has been safely used in the pancreatic duct.

In our video case, we present a 59-year-old man with a dilated main pancreatic duct who was diagnosed with a main duct—type IPMN at an outside facility and referred for total pancreatectomy. Using dye-based pancreatoscopy, we were able to accurately define the lesion, rule out skip lesions, and recommend a Whipple procedure instead of total pancreatectomy.

Chromo-pancreatoscopy may offer a promising approach to enhance visualization and characterization of main duct—type IPMNs, particularly in cases where traditional imaging modalities may be inconclusive.

By providing detailed mucosal visualization and aiding in targeted biopsies, chromo-pancreatoscopy may hold promise in improving diagnostic accuracy and guiding appropriate management strategies for patients with main duct—type IPMNs. Further research and clinical validation are needed.

I would like to thank GIE for the opportunity to share this interesting video case.

Magnetic resonance imaging demonstrating a diffusely dilated pancreatic duct in the body and tail of the pancreas (green arrow). The pancreatic duct in the pancreatic head appears to be nondilated (yellow arrow).

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