Background and Aims

Per-oral pancreatoscopy (POP) permits direct evaluation of the pancreatic duct for the visualization and sampling of neoplastic lesions and treatment of pancreatic duct stones by using intraductal lithotripsy techniques. Pancreatic laser endotherapy of mucosa has been described in animal models for tumor ablation, but human experience is lacking. We describe 3 unique and challenging clinical situations that benefited from pancreatic laser dissection and ablation.

Case description

Case 1 was a 75-year-old woman with presumed divisum-associated chronic pancreatitis who had recurrent acute pancreatitis despite minor papilla sphincterotomy and therapeutic stent placement. POP showed a side-branch intraductal papillary mucinous neoplasm within the neck of the pancreas. POP-guided holmium laser ablation of neoplastic tissue was performed, followed by pancreatic stent placement every 6 months, with no further hospitalizations at 20 months of follow-up. Case 2 was a 69-year-old woman with divisum-associated chronic calcific pancreatitis and recalcitrant mid-body stenosis. Previous attempts at balloon dilation and stent placement failed to resolve the stenosis. POP-guided holmium laser dissection of the stenosis was pursued, with immediate radiographic resolution. Case 3 was a 65-year-old woman with chronic calcific pancreatitis and a large stone burden who underwent POP-guided electrohydraulic lithotripsy and partial stone extraction followed by stent placement. Unfortunately, the stent fractured during the subsequent removal attempt because the fragment was impacted in the pancreatic body. POP-guided laser dissection and lithotripsy were used to debulk dense fibrous tissue and stones surrounding the stent fragment, respectively, followed by removal.

Conclusions

Pancreatoscopy-guided laser endotherapy is a novel and potentially useful technique to manage difficult benign and neoplastic pancreatic disorders.

中文翻译：

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胰腺镜引导下的激光解剖和消融治疗良性和肿瘤性胰腺疾病：初步报告（带视频）

背景和目标

经口胰镜检查（POP）可通过导管内碎石术直接评估胰管，以便可视化和取样肿瘤性病变并治疗胰管结石。在用于肿瘤消融的动物模型中已经描述了粘膜的胰腺激光内治疗法，但是缺乏人类经验。我们描述了受益于胰腺激光解剖和消融的3种独特且具有挑战性的临床情况。

案例说明

病例1是一名75岁的女性，患有推测的与消化道相关的慢性胰腺炎，尽管有轻度的乳头括约肌切开术和支架置入术，但仍复发性急性胰腺炎。POP显示胰腺颈内有侧支导管内乳头状粘液性肿瘤。POP引导-激光切除肿瘤组织，然后每6个月放置胰支架，随访20个月时无需进一步住院治疗。病例2是一名69岁的妇女，患有分裂相关的慢性钙化性胰腺炎和顽固的中体狭窄。先前进行球囊扩张和支架置入的尝试未能解决狭窄。进行了POP引导的laser激光对狭窄的解剖，并立即获得了射线照相分辨率。病例3是一名65岁的慢性钙化性胰腺炎和巨大结石负担的妇女，她接受了POP引导的电液压碎石术和部分结石摘除，然后置入支架。不幸的是，在随后的移除尝试中，支架破裂了，因为碎片撞击了胰体。POP引导的激光解剖和碎石术分别用于疏散支架碎片周围的致密纤维组织和结石，然后取出。

结论

胰腺镜引导下的激光内疗法是一种新颖且潜在有用的技术，可用于治疗困难的​​良性和肿瘤性胰腺疾病。