Narrative review reveals diagnostic and therapeutic utility of peroral pancreatoscopy for pancreatic duct disorders, highlighting its complementary role alongside conventional imaging.
Background: Peroral pancreatoscopy is an advanced endoscopic modality that enables direct visualization of the pancreatic duct. It may be useful when cross-sectional imaging, endoscopic ultrasound, or conventional endoscopic retrograde cholangiopancreatography do not provide sufficient information on intraductal pancreatic pathology. Aim: This review aimed to summarize the current diagnostic and therapeutic applications of peroral pancreatoscopy, with emphasis on intraductal papillary mucinous neoplasms, indeterminate pancreatic duct strictures or dilatation, and pancreatic duct stone disease. Material and methods: This narrative review was based on available literature concerning the clinical utility of peroral pancreatoscopy in pancreatic duct disorders. Particular attention was given to studies evaluating intraductal lesion morphology, preoperative and intraoperative mapping, diagnostic assessment of indeterminate ductal abnormalities, and pancreatoscopy-guided lithotripsy. Results: Current evidence suggests that pancreatoscopy may provide additional clinically relevant information in selected patients with intraductal papillary mucinous neoplasms by improving assessment of ductal morphology and disease extent. In indeterminate pancreatic duct strictures or unexplained ductal dilatation, it may support diagnostic evaluation through direct visualization and targeted tissue acquisition. Therapeutically, pancreatoscopy-guided lithotripsy has shown favorable efficacy in difficult pancreatic duct stones. However, broader use is limited by technical complexity, operator dependence, restricted availability, and adverse events, particularly post-procedural pancreatitis. Conclusions: Peroral pancreatoscopy is a valuable complementary tool in selected cases of pancreatic duct disease. Further prospective studies, procedural standardization, and consistent safety reporting are needed to define its role in routine practice.
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Sołtys et al. (2026) studied this question.
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