Direct Pancreatoscopy With an Ultrathin Forward-Viewing Endoscope in Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract

A 75-year-old man presented with jaundice and profound weight loss. Examination revealed icterus and muscle wasting. Laboratory evaluation was notable for levels of serum albumin of 1.5 g/dL, total bilirubin of 13 mg/dL, alkaline phosphatase of 429 U/L, and γ-glutamyl transpeptidase of 120 U/L. Serum amylase and lipase levels were normal. Magnetic resonance cholangiopancreatography (Figure A) revealed a markedly dilated proximal common bile duct (Figure A, A), normal caliber distal common bile duct measuring 8 mm, and a cystic structure in head of the pancreas (Figure A, B) communicating with the main pancreatic duct (MPD) (Figure A, C), suggestive of main duct type intraductal papillary mucinous neoplasm (IPMN).