Spyglass Fiber Through 19-Gauge Needle for Direct Viewing Inner Structure of Small IPMN

Abstract

Introduction: At present, the diagnosis of small IPMN mainly depends on the comprehensive analysis of CT, MRI/MRCP, EUS and so on,yet the diagnostic accuracy is low, and each has its limitation.Cyst wall and cyst content of the small pancreatic cystic neoplasms can be observed under direct vision through the peroral pancreatoscopy(POPS).However,Studies have indicated that, successful completion of the POPS requires sufficient MPD dilation (>3.5mm).And EUS-FNA guided Spyglass as a new type of examination tools,can stab into the cyst directly under the guidance of the EUS and observe the cyst wall and cyst content clearly. The aim of this study is to study the performance of small IPMN cyst wall and cyst content and assess the value of the diagnosis of small IPMN by EUS-FNA guided Spyglass. Methods: From April 2015 to may 2016,120 patients of small pancreatic cystic neoplasms were enrolled to perform EUS, among whom 59 patients finally received surgery.9 patients undergoing US and other imaging diagnosis of suspected small IPMN, received the EUS-FNA guided Spyglass.The patient examined by EUS firstly,then stabbed into the cyst by using the 19G puncture needle. Put the Spyglass probe into the cyst to conduct a preliminary observation.After the end of observation,drawn out the cyst fluid to carry out the analysis of cyst fluid consisted of cytological examination and biochemical examination and so on.Then flushed the cyst and displaced the cyst fluid by saline to get a clear view for Spyglass.Put the Spyglass probe into the cyst again to observe the cyst wall and cyst content. The “Egg liked papillary structure” we observed as a necessary condition.(chart 1) The “Multiple ridge structure”, “Rough cyst wall”, “Floccule”, “Dense vascular distribution” as minor condition.(chart 2) In line with the necessary condition and any two of the minor conditions as the diagnostic criteria to diagnose small IPMN.The diagnosis results were compared with the specific postoperative pathological diagnosis. Results: Seven patients were clearly diagnosed as small IPMN. Six patients were diagnosed as small IPMN by Spyglass. The sensitivity and specificity of the diagnosis by Spyglass were 85.7%, 100%.There were no obvious complications after Spyglass in 9 cases. Conclusion: EUS-FNA guided Spyglass is a safe and effective means of inspection. It can improve the diagnostic accuracy of small IPMN to those patients can not get a specific diagnose by CT,MRI/MRCP,US.Figure 1Figure 2