ERCP with per-oral pancreatoscopy–guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience

Attwell, Augustin; Patel, Sandeep; Kahaleh, Michel; Raijman, Isaac; Yen, Roy D.; Shah, Raj J.

doi:10.1016/j.gie.2015.01.020

Cited by 87 publications

(75 citation statements)

References 38 publications

(47 reference statements)

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“…However, biliary and pancreatic stones that cannot be removed by conventional techniques occur, and these difficult stones include very large stones, impacted stones, and stones in difficult locations, namely, cystic or intrahepatic stones and pancreatic stones that are large or proximal to a stricture. These difficult-to-remove stones need multiple procedures, extracorporeal shock wave lithotripsy, and even more invasive methods for complete ductal clearance [2-5]. …”

Section: Introductionmentioning

confidence: 99%

“…Recent reports have suggested that cholangioscopy-guided LL is a safe and effective technique for the treatment of difficult biliary and pancreatic stones, although the experience with pancreatic stones is more limited [2-5, 11, 12]. There is no reported experience in Portugal with the second-generation digital cholangioscopy-guided lithotripsy system using EHL or HL.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Endoscopic retrograde cholangiopancreatography is the preferred strategy for the management of biliary and pancreatic duct stones. However, difficult stones occur, and electrohydraulic (EHL) and laser lithotripsy (LL) have emerged as treatment modalities for ductal clearance. Recently, single-operator cholangioscopy was introduced, permitting the routine use of these techniques. We aimed to evaluate the clinical effectiveness of cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones. Methods: This is a prospective clinical study – conducted at two affiliated university hospitals – of 17 consecutive patients with difficult biliary and pancreatic stones who underwent single-operator cholangioscopy-guided lithotripsy using two techniques: holmium laser lithotripsy (HL) or bipolar EHL. We analyzed complete ductal clearance as well as the impact of the location and number of stones on clinical success and evaluated the efficacy of the two techniques used for cholangioscopy-guided lithotripsy and procedural complications. Results: Twelve patients (70.6%) had stones in the common bile duct/common hepatic duct, 2 patients (17.6%) had a stone in the cystic stump, and 3 patients (17.6%) had stones in the pancreas. Sixteen patients (94.1%) were successfully managed in 1 session, and 1 patient (5.9%) achieved ductal clearance after 3 sessions including EHL, LL, and mechanical lithotripsy. Eleven patients were successfully submitted to HL in 1 session using a single laser fiber. Six patients were treated with EHL: 4 patients achieved ductal clearance in 1 session with a single fiber, 1 patient obtained successful fragmentation in 1 session using two fibers, and 1 patient did not achieve ductal clearance after using two fibers and was successfully treated with a single laser fiber in a subsequent session. Complications were mild and were encountered in 6/17 patients (35.2%), including fever (n = 3), pain (n = 1), and mild pancreatitis (n = 1). Conclusions: Cholangioscopy-guided lithotripsy using LL or EHL in patients with difficult biliary or pancreatic stones is highly effective with transient and minimal complications. There is a clear need to further compare EHL and HL in order to assess their role in the success of cholangioscopy-guided lithotripsy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Canena

Lopes

Fernandes

et al. 2018

GE Port J Gastroenterol

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“…The role of POP in guiding treatment of pancreatic stones using electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) has been well established. 1,2 Its role in the identification, evaluation, and sampling of occult PD lesions that may not be visible by non-invasive imaging, transluminal endoscopic ultrasound (EUS), or pancreatography remains limited to case series. [3][4][5][6][7][8][9][10][11][12] The aims of this study are to: 1) evaluate the safety, efficacy, technical success, and adverse events of POP; and 2) determine the usefulness of POP for the differentiation of malignant from benign diseases of the pancreatic duct.…”

Section: Introductionmentioning

confidence: 99%

Role of per-oral pancreatoscopy in the evaluation of suspected pancreatic duct neoplasia: a 13-year U.S. single-center experience

Hajj

Brauer

Wani

et al. 2017

Gastrointestinal Endoscopy

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“…Cholangioscopy using the SpyGlass (Boston Scientific, Mass., Legacy & DS™) system is increasingly used for treating difficult bile duct stones, with stone clearance in 90-100% and pain relief in >90%. 4,5 In a recent overview by the ESGE in 2015, peroral cholangioscopy was included in the treatment options for bile duct stones, 6 but the ESGE guidelines from 2012 for pancreatic duct stones did not specify a role for EHL in the treatment for pancreatic stones in CP. 1 In 2015 a new single operator cholangiopancreatoscopy system was introduced, SpyGlass DS™ which included improved operating characteristics, compared with the previous system (SpyGlass legacy), including a x4 greater image resolution (240000 pixels)…”

Section: Introductionmentioning

confidence: 99%

Pancreatoscopy-Directed Electrohydraulic Lithotripsy for Pancreatic Ductal Stones in Painful Chronic Pancreatitis Using SpyGlass

et al. 2017

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ObjectivesPainful chronic pancreatitis (CP) is often associated with main duct obstruction due to stones.Approaches to management are challenging, including surgery, extracorporeal shock wave lithotripsy, or endoscopic approaches. Here we report our experience of pancreatoscopy + electrohydraulic lithotripsy (EHL) for pancreatic duct (PD) stones using SpyGlass. MethodsWe retrospectively audited the use of SpyGlass (Legacy & DS™) + EHL. Indication, procedural details, and clinical outcome were assessed. Results118 SpyGlass + EHL procedures for stones were performed, of which 8 (7%) for pancreatic stones, in 6 patients (3 female, mean age 45 years ±7 years). All patients had painful CP, with radiological evidence of a dilated PD, and main duct stone disease. Surgical options had been considered in all cases. Stone fragmentation and PD decompression was achieved in 83% (n=5) without complications. Two patients required two EHL procedures to achieve clearance. One patient failed clearance, pancreatoscopy revealed a stone in the adjacent parenchyme and not in PD. All patients with successful EHL had pain relief/marked improvement at clinical review (mean follow-up 2.7 ±1.1 years). ConclusionPancreatoscopy + EHL may have a valuable role in treating obstructing pancreatic ductal stones, possibly avoiding the need for surgery in some patients.

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ERCP with per-oral pancreatoscopy–guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience

Cited by 87 publications

References 38 publications

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Outcomes of Single-Operator Cholangioscopy-Guided Lithotripsy in Patients with Difficult Biliary and Pancreatic Stones

Role of per-oral pancreatoscopy in the evaluation of suspected pancreatic duct neoplasia: a 13-year U.S. single-center experience

Pancreatoscopy-Directed Electrohydraulic Lithotripsy for Pancreatic Ductal Stones in Painful Chronic Pancreatitis Using SpyGlass

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