Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

Han, Samuel; Miley, Angelina; Akshintala, Venkata S.; Freeman, Martin L.; Kahaleh, Michel; Othman, Mohamed O.; Patel, Sandeep; Papachristou, Georgios I.; Raijman, Isaac; Sankey, Noel; Sayana, Hari; Singh, Vikesh K.; Tarnasky, Paul R.; Trikudanathan, Guru

doi:10.1016/j.pan.2022.09.245

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Based on shock wave energy, this technique overcomes the challenging extraction of larger (>5 mm) or impacted stones with ERCP alone, by fragmenting the PDSs before endoscopic removal and, as a result, increasing the clearance rates up to 60–90% [ 2 , 3 , 17 ]. As a result, ESWL is suggested as the first-line treatment for the management of PDSs >5 mm [ 12 ]. The shock waves produce compressive stress, which reduces the size of the stones into fragments of <3 mm, as it overcomes their tensile strength [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Its drawbacks are the cost and the requirement for experience with the device, adequate diameter of the pancreatic duct, the diameter of the pancreatoscope, the long duration of the process, and the mediocre success rates of standard methods [ 23 ]. Pain aggravation is considered the most common adverse event (AE), whereas cholangitis, cholecystitis, and duodenoscope-related infection transmissions are rarely encountered [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic duct stones (PDSs) typically cause obstruction, and, consequently, hyper-tension of the distal part of the duct, elevated parenchymal pressure, ischemia, and inflammation of the pancreatic nerves, which can cause abdominal pain, insufficient exocrine pancreatic function, and other complications such as obstructive jaundice, diabetes, and steatorrhea [ 10 , 11 ]. Pancreatic pain is associated with a reduced quality of life, as it is sometimes combined with weight loss and low work productivity, and is regularly treated with opiates, which can cause dependence and hospitalization [ 11 , 12 ]. Consequently, it is essential to restore pancreatic duct flow, either with medical, endoscopic, or surgical therapy [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

Paramythiotis,

Karlafti,

Kollatou

et al. 2024

Am J Case Rep

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Case series Patients: Male, 78-year-old • Female, 27-year-old Final Diagnosis: Pancreatic duct stones Symptoms: Abdominal pain Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Pancreatic calculi (PC) or pancreatolithiasis refers to the presence of stones in the main pancreatic duct (MPD), side branches, or parenchyma of the pancreas. It is highly associated with chronic pancreatitis (CP), and is present in 50-90% of those patients. The stone formation can be attributed to a diversity of factors, all of them leading to obstruction in the duct, hypertension of its distal part, increased intraductal and parenchymal pressure, and inflammation, causing the standard symptom, epigastric pain. Immediate restoration of pancreatic secretion flow is of utmost importance and can be achieved with both endoscopic and surgical techniques. Endoscopic techniques include endoscopic retrograde cholangiopancreatography (ERCP) combined, if possible, with extracorporeal shock wave lithotripsy (ESWL), while surgical techniques consist of drainage and resection procedures. The choice of treatment for PC depends on the location, size, and number of stones, and the existence of other complications. Case Reports: We present 2 cases that were diagnosed with PC, in which clinical symptoms, laboratory results, and imaging examinations were different, suggesting the variety of manifestations pancreatolithiasis can cause. Each patient was treated differently, according to their clinical situation and the presence or absence of complications. Both patients were discharged and fully recovered. Conclusions: The management of pancreatolithiasis can be demanding in some cases, mostly when there are complications. The purpose of this case report is to indicate the importance of personalized treatment for each patient, as different approaches to the same medical condition should be easily identified and successfully treated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

Paramythiotis,

Karlafti,

Kollatou

et al. 2024

Am J Case Rep

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“…nounced trial which directly compares per-oral pancreatoscopy-guided lithotripsy to ESWL for treating refractory main PD stones in CP [18]. Second, due to the non-randomized retrospective nature of the present long-term follow-up study there is a possibility of selection bias.…”

Section: E303mentioning

confidence: 98%

Long-term outcomes of pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones

et al. 2023

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Background and study aims Pancreatoscopy-guided electrohydraulic lithotripsy (EHL) has proven to be an effective first-line therapy in symptomatic chronic pancreatitis (CP) patients with obstructing pancreatic duct (PD) stones 1. However, long-term outcomes of endoscopic EHL remain unknown. The aim of the present study was to evaluate the long-term treatment effects of EHL as first-line therapy and to compare with those obtained in a historical cohort of patients who underwent extracorporeal shockwave lithotripsy (ESWL) as primary treatment. Patients and methods An observational retrospective single-center long-term follow-up study was performed including 19 consecutive patients who previously underwent endoscopic EHL compared to 18 patients who underwent ESWL followed by endoscopic retrograde pancreatography (ERP). The primary endpoint was long-term treatment success after EHL or ESWL defined as no recurrence of symptomatic intraductal stones confirmed on imaging. Secondary endpoints for the EHL-population included long-term clinical success (i. e., a similar or lower Izbicki Pain Score or reduction in opiate usage as compared to 6-month follow-up), quality of life (QoL), pancreatic function and hospital re-admission rate. Results In the EHL group, 37 % of the patients developed recurrent symptomatic PD stones versus 61 % in the ESWL group after a median follow-up of 35.0 and 76.5 months. Of the patients with recurrence, 71 % versus 100 % underwent a reintervention. Median time to recurrence was 12.0 versus 13.0 months. Clinical success sustained in 58 % of the EHL patients. QoL was not significantly different compared with 6-month follow-up and baseline. Conclusions Also at long-term follow-up, endoscopic EHL as first-line treatment is moderately effective for symptomatic CP patients with treatment success rates that seems at least equally effective as ESWL.

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“…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].…”

Section: Extracorporeal Shockwave Lithotripsy and Pancreatoscopymentioning

confidence: 99%

Endotherapy in pediatric pancreatitis

Norris

Troendle

2023

Current Opinion in Gastroenterology

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Purpose of review Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research. Recent findings Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection. Summary Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.

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Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

Cited by 7 publications

References 23 publications

Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

Pancreatolithiasis: Does Management Depend on Clinical Manifestations?

Long-term outcomes of pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones

Endotherapy in pediatric pancreatitis

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