Peroral pancreatoscopy (POPS) is an endoscopic procedure that allows for direct visualization of the main pancreatic duct (MPD) along with to sample tissue and perform directed local therapy. This study evaluates POPS assessment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with MPD involvement.

A retrospective, cross-sectional study was conducted on individuals with IPMN who underwent POPS using the Boston Scientific Spyglass system at a tertiary medical center between 2020-2023. Multivariate logistic regression evaluated the association between both quality of visualization, as well as pathological results, and IPMN with MPD involvement. In addition, a univariate logistic regression model was applied to determine whether POPS independently influenced management of these individuals.

Eleven patients who underwent POPS were evaluated. Among them, 7 (63.6%) were males and the mean age was 57 + 13. Eight (72.7%) had main duct IPMN, two (18.2%) had mixed-type IPMN, and one (9.1%) had branch-duct IPMN. Quality of visualization was good in all individuals. No suspicious lesions were found and no targeted biopsies were taken. Random biopsies were successfully taken in 10 (90.9%) patients. Biopsy specimens did not show malignant or premalignant lesions (including dysplasia of any grade). Benign neoplastic epithelium was found in 3 individuals (27.2%), all with main duct IPMN. In one case (9.1%) biopsies showed mild atypia with reactive and regenerative changes. Post-POPS prophylactic pancreatic stent was inserted in 4 (36.3%) patients. Post-POPS complications were observed in one patient (9.1%) who developed asymptomatic mild hyperamylasemia and one patient (9.1%) who developed mild post-POPS pancreatitis. POPS results did not change the pre-POPS multidisciplinary decision or the management in any of the patients.

POPS appears to be feasible and safe, but did not impact clinical management among patients with IPMN of the pancreas with suspected MPD involvement.