Su1422 CHOLANGIOPANCREATOSCOPY-GUIDED SOFT TISSUE LASER DISSECTION AND ABLATION FOR REFRACTORY STRICTURES AND NEOPLASIA

Abstract

Benign pancreas and biliary strictures may be refractory to stenting. Safety data exists for laser tissue dissection in ex vivo biliary studies. Cholangiopancreatoscopy-guided laser dissection or ablation (CPL) provides a novel therapeutic modality that could be an alternative to surgical intervention. The primary aim of this study is to describe the safety and efficacy of CPL for a variety of pancreas and biliary disorders. A single-center retrospective review of patients who underwent CPL between 7/16-10/19. Holmium (Litho, Quanta System) or Thulium (Cyber TM, Quanta System) laser units with a 200-272μm fiber (International Medical Lasers) were used under saline immersion (frequency 8-20 Hz, energy 0.5 joules, power 5-20 Watts). Compared to holmium, thulium provides a continuous wave that has a shallow depth of penetration beneficial in dissection or ablation. For stricture dissection, gentle contact of the laser from a distal to proximal stroke was applied until lumen patency permitted advancement of the 10.5Fr cholangiopancreatoscope (SpyGlass DS, Boston Scientific) followed by balloon dilation and stenting. The definition of immediate technical success was the ability to traverse the stricture with the cholangiopancreatoscope after CPL and short-term technical success was improvement of the stricture from pre-CPL compared to subsequent ERCP. Descriptive statistics were used for patient characteristics and treatment details. In all, 11 patients (mean age of 58, 90.9% female) underwent a mean of 3.6 ERCP’s (mean total diameter of 14.2 Fr of stenting) prior to CPL (Table 1). Indications included pancreatic duct stricture (n=8, 72.7%), pancreaticojejunostomy anastomotic stricture (n=1), bile duct stricture (n=1) and pancreatic intraductal papillary mucinous neoplasm ablation (IPMN) in a medically inoperable patient with recurrent acute pancreatitis (n=1). 17 (median 1, range 1-3) CPL sessions were performed and holmium was used most frequently (73.3%) with a median energy delivered of 8.5 KJ (Table 2). There was one adverse event of pneumonia; no post-ERCP pancreatitis was noted. At mean follow-up of 11.5 months, immediate and short-term technical success rates were 92.9% (13/14 strictures) and 85.7% (12/14 strictures). In 63.6% (n=7) of patients, CPL of strictures permitted access to impacted pancreatic duct stones for concomitant laser lithotripsy. The patient with IPMN had no further hospitalizations for pancreatitis. 1) CPL for strictures of the pancreatic duct refractory to conventional dilation and multiple stenting carries a high rate of technical success and is safe. 2) CPL of downstream strictures can facilitate access to impacted stones for laser lithotripsy. 3) Larger studies with a control population are required to further validate this technique.Laser treatment detailsView Large Image Figure ViewerDownload Hi-res image Download (PPT)