A comparative study between single-operator pancreatoscopy with intraductal lithotripsy and extracorporeal shock wave lithotripsy for the management of large main pancreatic duct stones

Extracorporeal shock wave lithotripsy for pancreatic duct stones in patients with chronic pancreatitis: Are we underutilizing a new technology?

“…More specifically, older patients with a single intraductal obstructing stone within the head/neck of their pancreas and associated chronic pancreatitis pain and who are ineligible for either surgical or isolated ERCP-based interventions may benefit from ESWL. In comparison to studies reporting the efficacy of ESWL, 5 – 7 , 9 , 11 – 13 we found that our patients showed a comparable “pain free” status (69%) and aligned well with the recommended indications and subsequent complications (i.e., pancreatitis). Although our analysis was limited by very narrow selection criteria (as discussed above), and therefore selection bias, we cannot comment on the utility of ESWL in less restricted patient populations with chronic pancreatitis.…”

“… 6 These findings are also supported by other smaller unifocal series as well as data comparing ESWL to ERCP-based therapy (i.e., single-operator pancreatoscopy with intraductal [intracorporeal] lithotripsy [SOPIL]). 5 , 7 Additional comparisons between surgical and endoscopic approaches have also shown that although surgical decompression results in improved long-term outcomes, 8 not all patients are amenable to surgery. Requirements for surgical candidacy include abstinence from alcohol and smoking; presence of a firm/hard pancreatic gland, as confirmed by preoperative radiologic evidence (calcifications and morphologic changes); presence of a large main duct; patient mental and physical engagement in the perioperative process; and a willingness to participate in postoperative narcotic reduction strategies.…”

Electrohydraulic lithotripsy through endoscopic retrograde cholangiopancreatography combined with SpyGlass in the treatment of complex pancreatic duct stones: A case report and literature review

“…Among them, ESWL utilizes a confined space to release shock waves instantly, smashes pancreatic duct stones in vitro , and achieves the purpose of clearing stones through spontaneous expulsion or subsequent ERCP. A retrospective cohort study by Benjamin L et al ( 25 ) showed that 240 patients were treated with ESWL, and 18 were treated with single-operator pancreatoscopy with intraductal (intracorporeal) lithotripsy (SOPIL). The overall technical success rate of stone clearance was 224/258 (86.8%), which was similar between the ESWL and SOPIL groups (86.7% vs. 88.9%, p = 1.000).…”

“…Among them, ESWL utilizes a confined space to release shock waves instantly, smashes pancreatic duct stones in vitro, and achieves the purpose of clearing stones through spontaneous expulsion or subsequent ERCP. A retrospective cohort study by Benjamin L et al (25) showed that 240 patients were treated with Given that, ESWL and SOPIL are safe and effective endoscopic adjunct modalities for treating large pancreatic duct stones. SOPIL is an emerging alternative to ESWL that is potentially more efficient for lithotripsy and MPD stone clearance.…”

Endotherapy in pediatric pancreatitis

“…In this case, direct per-oral pancreatoscopy with intraductal electrohydraulic lithotripsy may be an alternative. Adult case series are growing with a randomized trial is on the horizon [19][20][21]. Pediatric experience with single operator cholangioscopy (SpyGlass, Boston Scientific, USA) remains limited to single center reviews, and its use for pediatric pancreatoscopy is further limited to case reports [22,23].…”