Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis.

Ken Ito,Naoki Okano,Kensuke Takuma,Yui Kishimoto,Takahiko Mimura,Seiichi Hara,Yoshinori Igarashi

doi:10.1155/2014/732781

Abstract

Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis. Methods. For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options. Results. Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003). Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

Highlights

To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis
Complications of ESWL include acute obstructive pancreatitis due to stone lithotripsy, and patients should be admitted for postmonitoring of ESWL and for preventing complications requiring endoscopic pancreatic sphincterotomy (EPST) [3]
Management in cases of large-diameter stones requires lithotripsy, for which combined endoscopic treatment (ET)/ESWL therapy is more effective than ESWL therapy alone [4]

Summary

Introduction

Pancreatic lithiasis in chronic pancreatitis, especially in the main pancreatic duct (MPD), may cause pain due to pancreatic stasis or increased MPD pressure. Management in cases of large-diameter stones requires lithotripsy, for which combined endoscopic treatment (ET)/ESWL therapy is more effective than ESWL therapy alone [4]. Our department performs EHL as a second treatment option, and, in the event that EHL is unsuccessful, outpatient ESWL is performed in cases of temporary pain relief or radiolucent stones. To evaluate the efficacy of combined endoscopic lithotomy and ESWL, and additional EHL as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated cases of symptomatic pancreatic duct stones treated at our institution. Clinical success (improvement in abdominal complaints) and technical success (clearance of target pancreatic stone) and the efficacy of POPS guided EHL and direct EHL were evaluated as follows. Technical success is defined as clearance of the target pancreatic stone after the treatment (e.g., endoscopic treatment/ESWL/EHL). Comparisons of the outcome variable (stone fragmentation) were analyzed using the Chi-squared test or Fisher’s exact test

Results

Discussion

Conclusions