The Role of Endoscopy for the Diagnosis of Intraductal Papillary Mucinous Tumor of the Pancreas

Intraductal papillary mucinous tumor is a recently recognized rare pancreatic tumor. Because the tumor includes a broad spectrum of malignancy grade, preoperative assessment of disease extent and differentiation between benign and malignant forms are essential. Among a variety of diagnostic modalities, endoscopy plays important roles to assess intraductal papillary mucinous tumor. ERCP is a traditional diagnostic tool and enables pancreatic juice sampling for cytology and guided forceps biopsy. EUS is an accurate modality for the diagnosis of intraductal papillary mucinous tumor. Certain endosonographic features are highly indicative of a malignancy. The addition of fine needle aspiration capability further enhances diagnostic accuracy. IDUS can be used for a more detailed evaluation of intraductal papillary mucinous tumor in assessing the intraductal spread of the tumor and its pancreatic parenchymal invasion. Pancreatoscopy makes possible a definite diagnosis of intraductal papillary mucinous tumor allowing biopsy under direct vision and provides valuable information in assessing the extent of the lesion. Newly developed video pancreatoscope makes it possible to make a more detailed morphologic assessment of the tumor and its grade of malignancy. With a combination of these endoscopic modalities, intraductal papillary mucinous tumor can now be effectively imaged and diagnosed preoperatively.