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successfully for direct histological imag− ing of the gastrointestinal mucosa during endoscopy [1 ± 3]. However, there are no published reports on the intraoperative use of the endocytoscope. This is the first report describing the intraoperatiave use of the endocytoscope for the detection of carcinoma in a patient with chronic pan− creatitis. A 44−year−old man with longstanding chronic pancreatitis presented with re− current episodes of abdominal pain and significant weight loss. His CA19± 9 level was raised at 392 U/mL (normal range 0± 25 U/mL). Computed tomography showed changes typical of chronic pan− creatitis, but no evidence of tumor. Elec− tive pancreaticojejunostomy was planned because there were multiple strictures in the pancreatic duct. Intraoperatively, the head of pancreas was bulky but there was no palpable mass. The pancreatic duct was opened and showed a long stric− ture with ulcerations in the head region. It was decided that endocytoscopic evalu− ation might be useful in order to assess the type and extent of the lesion. The opened pancreatic duct was sprayed with sterilized methylene blue dye (l" Fig. 1). The body region of the pancre− atic duct was examined first in order to familiarize ourselves with the normal cy− toanatomy of the duct, and then we looked at the suspicious area in the head region, which showed clusters of tumor cells with hyperchromatic nuclei and a high nuclear−cytoplasmic ratio (l" Fig. 2). This pattern was found only in the head of the pancreas. A biopsy of this tissue was sent for frozen section examination and subsequently for conventional histopa− thological examination, which showed malignancy, confirming the endocytosco− py findings (l" Fig. 3). In conclusion, endocytoscopy assisted in making a diagnosis of carcinoma on a background of chronic pancreatitis, by visualizing variation in cell size, disorder of polarity, and deformity of the nuclei. This optical biopsy technique could be useful for the immediate diagnosis of mi− totic lesions, definition of the extent of these lesions, and assessment of the ne− gativity of resection margins during sur− gery.

Endocytoscopy assists in the intraoperative diagnosis of carcinoma in a patient with chronic pancreatitis