Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones

Abstract

Background and study aims The role of the digital single-operator pancreatoscopy (D-SOP) with electrohydraulic (EHL) or laser lithotripsy (LL) in treating pancreatic ductal stones is unclear. We investigated the safety and efficacy of D-SOP with EHL or LL in patients with obstructing pancreatic duct stones. Patients and methods Retrospective analysis of 109 patients who underwent D-SOP for pancreatic stones at 17 tertiary centers in the United States and Europe from February 2015 to September 2017. Logistic regression was performed to identify factors associated with the need for more than one D-SOP with EHL/LL. Results Most patients were males (70.6 %),mean age 54.7 years. Fifty-nine (54.1 %) underwent EHL and 50 (45.9 %) underwent LL. Mean procedure time was longer in the EHL group (74.4 min vs 53.8 min; P < 0.001). Ducts were completely cleared (technical success) in 89.9 % of patients (94.1 % in EHL vs 100 % in LL; P = 0.243), achieved in a single session in 73.5 % of patients (77.1 % by EHL and 70 % by LL; P= 0.5).D-SOP failed in 11 patients (10.1 %); 6 patients were treated with extracorporeal shockwave lithotripsy (ESWL), 1 with surgery,1 with combined treatment (ESWL + D-SOP EHL) and 3 with other. Fourteen adverse events occurred in 11 patients (10.1 %). Patients with more than three ductal stones were more likely to have technical failure compared to those with less than three stones (17 % vs. 4.8 %; P = 0.04). Having more than three stones was independently associated with the need for more than one D-SOC EHL/LL session (OR 2.94, 95 % CI 1.13 – 7.65). Conclusion D-SOP with EHL or LL is effective and safe in patients with pancreatic ductal stones.

Per-oral pancreatoscopy with intraductal lithotripsy for difficult pancreatic duct stones: a systematic review and meta-analysis

“…A total of 10 studies (n = 302 patients) were included in this meta-analysis [27][28][29][30][31][32][33][34][35][36]. A PRISMA flow chart of search results is shown in ▶ Fig.…”

Do available data support the widespread adoption of pancreatoscopy guided-lithotripsy?

“…The most consistent study concerns a retrospective analysis involving 17 centers in the United States and Europe, where just over 100 cases (about 6 patients per center!) treated with POPS-gl were enrolled during 3 years[ 3 ]. In others published reports, describing a systematic review[ 4 ] and a retrospective multicenter cohort[ 5 ], the authors collected a total of 87 and 28 patients, respectively.…”

Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

“…Pancreatic duct (PD) stones are a common complication of chronic pancreatitis (CP), which can lead to obstruction of the PD and cause chronic abdominal pain and exocrine pancreatic insufficiency[ 1 ]. PD stones may be present in as many as 50%-90% of CP patients[ 1 , 2 ]. The cause of the pain is multifactorial, but is thought to be secondary to elevated pancreatic ductal pressures, elevated interstitial pancreatic pressure, ischemia, fibrosis, and inflammation-related injury to the nerves innervating the pancreas[ 1 ].…”

“…Current management of symptomatic PD stones includes medical therapy such as pancreatic enzyme replacement therapy (PERT), extracorporeal shock wave lithotripsy (ESWL) with or without endoscopic retrograde cholangiopancreatography (ERCP), ERCP with pancreatic sphincterotomy and either balloon or basket retrieval with stent placement, peroral pancreatoscopy and/or surgery[ 1 , 2 ]. According to the 2018 European Society of Gastrointestinal Endoscopy (ESGE) and the 2017 United European Gastroenterology (UEG) guidelines, ESWL is the first line approach for patients with painful PD stones who have failed in medical therapy and who have stones greater than 5 mm[ 3 , 4 ].…”