Lithotripsy Of Pancreatic Duct Stones Research Articles

Pancreatoscopy-Guided Lithotripsy for Pancreatic Duct Stones: A Systematic Review and Meta-Analysis

Pancreatoscopy-Guided Lithotripsy for Pancreatic Duct Stones: A Systematic Review and Meta-Analysis

Laser lithotripsy for pancreatic duct stones

Aim. To confirm the possibility of minimally-invasive laser procedure for fragmentation of stones in the pancreatic duct following the results of laboratory experiments and medical practice. Materials and methods. A fully functional hardware complex consisting of a pulsed laser unit, video endoscopic system and cooling system was created for experimental stone fragmentation in laboratory. The experiments involved microscopic video registration of the fragmentation process, pressure and temperature measurement in the stone area. Pancreatic stones, human and artificial gallstones as well as porcine pancreas were used in the experiments; the gastrointestinal tract was made of silicone, the pancreas was made of gelatin aqueous solution jelly. In clinical practice, a patient with lithiasis of Wirsung's duct was assigned to ultrasound and CT, then endoscopic papillosphincterotomy, endoscopic pancreatoscopy, laser lithotripsy and lithoextraction, pancreatic duct stenting. The procedures involved a laser unit, videoduodenoscope, catheter and their video systems. Results. The laboratory experiments established that effective and safe laser fragmentation of stones from 4 × 7 mm into 0.1–2 mm occurs in the flowing fluid in front of the stone at 1 μs laser pulse duration, 5–15 Hz frequency and 120–150 mJ laser energy. After laser fragmentation of the stone in a patient with virsungolithiasis and removal of fragments from the duct, the patient was discharged from the hospital on the 12th day due to improvement of healthcondition. Conclusion. The possibility of minimally-invasive fragmentation of stones in the pancreatic duct by laser lithotripsy has been proved.

EUS-guided laser lithotripsy for pancreatic duct stones after failed conventional pancreatic endotherapy.

The central dogma of pain in patients with chronic pancreatitis revolves around the pathophysiology of ductal hypertension owing to stones that obstruct the pancreatic duct. Conventional modalities available to decompress the pancreatic duct are occasionally limited by failed selective pancreatic duct cannulation during endoscopic retrograde cholangiopancreatography. We describe a novel endoscopic approach of EUS-guided laser lithotripsy to assist in pancreatic duct (PD) stone fragmentation in two symptomatic patients with underlying chronic pancreatitis who had failed PD cannulation and extracorporeal shock wave lithotripsy (ESWL). In both cases, a 365-micrometer LightTrail TracTip Holmium laser fiber was advanced within a 19G endoscopic ultrasound aspiration needle (Expect Slimline (SL), Boston Scientific, Marlborough, Massachusetts, United States) under endoscopic ultrasound (EUS) guidance to fragment the PD stones. There were no procedure-related complications encountered and follow-up after 1 month of the procedure revealed significant reduction in abdominal pain scores. To the best of our knowledge, these are the first reported cases of EUS-guided laser lithotripsy performed for PD stones. Our approach of performing laser lithotripsy under EUS guidance obviates the need for an ESWL procedure; however, it is technically more challenging and requires precision to avoid injury to the pancreas. Further prospective studies are required to evaluate the safety and efficacy of this novel approach and its applicability as either a rescue procedure or in tandem with conventional pancreatic endotherapy modalities.

Extracorporeal shock wave lithotripsy for pancreatic duct stones in patients with chronic pancreatitis: Are we underutilizing a new technology?

The progressive inflammatory nature of chronic pancreatitis and its sparse therapeutic toolbox remain obstacles in offering patients durable solutions for their symptoms. Obstruction of the main pancreatic duct by either strictures or stones represents a scenario worthy of therapeutic focus, as nearly all patients with pancreatitis eventually have intraductal stones. A more recent option for removal of main duct stones is extracorporeal shock wave lithotripsy (ESWL). In an effort to explore the role of ESWL in a Canadian setting, we evaluated our initial experience over an 8-year period (2011-2019).

Extracorporeal shock wave lithotripsy for pancreatic duct stones in symptomatic chronic pancreatitis

Extracorporeal shock wave lithotripsy for pancreatic duct stones in symptomatic chronic pancreatitis

Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery.

Percutaneous single-operator video cholangioscopy using a novel short disposable endoscope: first clinical case with treatment of a complex biliary stone and inaccessible papilla after Roux-en-Y reconstructive surgery.

SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis.

Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) ( P < 0.01). Clinical success was achieved in 95 % of patients. Conclusions Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

Electrohydraulic Lithotripsy for Pancreatic Duct Stones Under Digital Single-Operator Pancreatoscopy (with Video).

Recently, a digital single-operator cholangiopancreatoscope (DSOC) has become available. This system allows the performance of electrohydraulic lithotripsy (EHL) even within the main pancreatic duct (MPD). However, there are only few reports of EHL for MPD stones using SPY-DS. The aim of this study was to evaluate the technical feasibility and efficacy of EHL for MPD stones under DSOC guidance. Between October 2016 and August 2017, patients with MPD stones were retrospectively enrolled in this study. The presence of MPD stones was diagnosed by endoscopic ultrasound and MRCP. The patients' baseline characteristics and those of the stones, including their size, number, and site in the MPD, number of EHL procedures, and adverse events, were reviewed. A total of 21 patients were retrospectively enrolled. The etiologies of chronic pancreatitis were idiopathic (n = 4) and alcohol induced (n = 17). The pancreatic stone was variously located in the head (n = 6), body (n = 11), tail (n = 1), head and body (n = 2), and body and tail (n = 1) of the pancreas. Median pancreatic stone size was 12mm, and the mean number of ERCP sessions was 1.29 (range 1-3). EHL was successfully performed in 15 patients (85.7%, 18/21), and the rate of complete stone clearance was 88.2% (18/21). Severe adverse events were not seen in any of the patients, although one patient developed mild acute pancreatitis. In conclusion, although additional case reports and prospective studies are needed, EHL under DSOC may be an option to treat MPD stones.

Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study

Introduction: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups.Aim: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS.Methods: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as ‘pain-free without analgesics or with use of weak analgesics as needed’. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048).Results: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03–1.16; p = .002) as did location of the stone in the head or neck (OR 2.59;1.04–6.45; p = .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p = .002) and the location of the stones (p = .039).Conclusion: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.

Digital Pancreatoscopy Guided Electrohydraulic Lithotripsy for Pancreatic Duct Stones - A Multicenter Experience

Digital Pancreatoscopy Guided Electrohydraulic Lithotripsy for Pancreatic Duct Stones - A Multicenter Experience

Current role of endoscopic pancreatoscopy.

To provide an overview of the field of pancreatoscopy and to summarize the data informing its clinical utility. Regarding the technological advance of pancreatoscopy, recent studies are the first to report the use of digital, single-operator pancreatoscopy (SpyGlass DS; Boston Scientific, Natick, MA). New data on the use of preoperative pancreatoscopy offer promising results for the potential to optimize treatment of intraductal papillary mucinous neoplasms and to differentiate between benign and malignant pancreatic strictures. Finally, there has been accumulating evidence for the use of pancreatoscopy-guided lithotripsy for the management of painful chronic calcific pancreatitis. Endoscopic pancreatoscopy offers the advantage of direct visualization of the pancreatic duct, allowing for optimal macroscopic assessment, targeted tissue acquisition and guided therapies such as lithotripsy of pancreatic duct stones. The data informing some aspects remain limited, but the accumulating literature forms our understanding of the current and future role of pancreatoscopy in the management of pancreatic disease.

PTH-099 External Shockwave Lithotripsy (eswl) Of Pancreatic Calculi Improves Pain Related To Chronic Calcific Pancreatitis

IntroductionChronic calcific pancreatitis is associated with the development of pancreatic ductal calculi. The calculi can lead to the blockage of the pancreatic duct which can increase the pressure in the...

Chronic Calcific Pancreatitis: Combination ERCP and Extracorporeal Shock Wave Lithotripsy for Pancreatic Duct Stones

Chronic pancreatitis is commonly associated with debilitating abdominal pain, in part due to pancreatic duct obstruction. Pancreatic stones are often impossible to extract from the duct with endoscopic retrograde cholangiopancreatography alone. Extracorporeal shock wave lithotripsy (ESWL) is commonly used for fragmentation of obstructing nephrolithiasis and has demonstrated effectiveness in management of pancreatic stones. Our aim was to examine the outcomes of the first 30 patients with symptomatic pancreatic stones treated with a combination of ESWL and endoscopic therapies. Patients with symptomatic chronic calcific pancreatitis referred for ESWL (2005-2009) were included. Technical success of ESWL was defined as a) stone fragmentation sufficient to allow extraction of main duct stones at ERCP or b) absence of the targeted main pancreatic duct stones on follow-up radiography. Clinical success of ESWL was defined by Patient Global Impression of Improvement (PGII) score of at least slightly improved. Thirty patients underwent ESWL. One patient was excluded due to adenocarcinoma. Technical success was achieved in 17/29 (58.6%) patients. 25 (86.2%) patients were available for follow-up (median 35 months, range 3-52 months). Fifteen of twenty-five (60%) patients experienced clinical improvement (10 patients very much improved), but there was no significant reduction in the proportion taking narcotics (50% before vs. 44.4% after ESWL). Pancreatic surgery has been avoided to date in 16 (64%) of the 25 patients. A multidisciplinary approach, combining ERCP and ESWL, to painful obstructing pancreatic duct stones provided symptomatic improvement and allowed pancreatic surgery to be avoided in the majority of patients.

Biliary and pancreatic stone extraction devices

Biliary and pancreatic stone extraction devices

Extracorporeal shock wave lithotripsy of pancreatic duct stones and patient factors related to stone disintegration

Stones in the main pancreatic duct (MPD) are difficult to remove by endoscopic devices alone in some patients who have chronic pancreatitis. We treated these patients with extracorporeal shock wave lithotripsy (ESWL) and analyzed the patient factors related to disintegration. Twenty-four patients were treated with ESWL alone or with combined endoscopic-ESWL to disintegrate or remove MPD stones. Ten patients were treated by ESWL alone and 14 by combined endoscopic-ESWL. A total of 19 patients (79%) were effectively treated by either method. The mean MPD diameter decreased significantly after ESWL. In most of the patients who had chronic abdominal symptoms, these symptoms were relieved at discharge. Severe side effects of complications did not occur during ESWL therapy. Acute abdominal symptoms and a significant increase in the white blood cell count, total bilirubin, and aspartate aminotransferase were observed only immediately after ESWL. Although there were no significant differences, we observed that the patients with a higher stone disintegration success rate showed the following factors: (1) female, (2) non-alcoholic pancreatitis, (3) younger age, (4) shorter duration of symptoms, (5) smaller stones, and (6) a lower Hounsfield unit value of stones. Although about half of the patients had recurring abdominal symptoms and stones during a follow-up period of 12 months, the stones which caused relapse in short-term intervals were disintegrated easily by ESWL. We may consider the application of ESWL therapies for patients who show the factors associated with easily disintegratable stone conditions. These therapies are highly effective and relatively safe procedures for pancreatic duct stones in such patients.

4692 Recalcitrant pancreatic duct stones: successful removal following mechanical lithotripsy.

Pancreatic duct stones are usually a consequence of chronic pancreatitis. The presence of PD stones can result in acute exacerbation of pancreatitis or chronic abdominal pain. Successful removal of PD stones has been achieved in over 70% of patients from both ducts of Wirsung (ventral) and Santorini (dorsal). Limitations include adherent or large stones and the relative small size of pancreatic sphincterotomies. AIM: To determine the feasibility and effectiveness of mechanical lithotripsy of pancreatic duct stones. METHODS: Ninety-five patients with PD stones, including 28 patients with pancreas divisum in the setting of chronic pancreatitis over a 15 year period were identified using a computer data base retrieval system. Forty-two patients presented with acute pancreatitis while 53 patients presented with exacerbation of their abdominal pain. Of these, 13 patients required mechanical lithotripsy and are the subject of this report. Nine of 13 patients had single stones (8-12 mm) while 3 of 13 patients had multiple stones (6-10 mm). Ducts were dilated in all patients (6-16 mm). RESULTS: Successful stone extraction required 1-3 (mean 1.8 sessions). Endoscopic sphincterotomy was performed in all patients. Single stones were extracted in 8 of 9 patients (89%), multiple stones in 3 of 4 patients (75%). PD stents were placed after initial attempts at extraction (=5)and palliation (=2). Of the 2 patients with unsuccessful stone extraction, 1 underwent pancreaticojejunostomy with good long-term results. Of the 2 patients with failed stone extraction, both were treated intermittently with stents with recurrent symptoms (mean follow-up 3.8 years). Nine of 11 patients had complete stone extraction with 8 of these patients with good long-term (no pain/pancreatitis) results and no recurrence (mean follow-up 4.2 years). CONCLUSION: Endoscopic removal of recalcitrant PD stones can be accomplished in the majority of pts by mechanical lithotripsy with good long-term outcome. Those failing endoscopic therapy will often respond to surgical options. Pancreatic duct stones are usually a consequence of chronic pancreatitis. The presence of PD stones can result in acute exacerbation of pancreatitis or chronic abdominal pain. Successful removal of PD stones has been achieved in over 70% of patients from both ducts of Wirsung (ventral) and Santorini (dorsal). Limitations include adherent or large stones and the relative small size of pancreatic sphincterotomies. AIM: To determine the feasibility and effectiveness of mechanical lithotripsy of pancreatic duct stones. METHODS: Ninety-five patients with PD stones, including 28 patients with pancreas divisum in the setting of chronic pancreatitis over a 15 year period were identified using a computer data base retrieval system. Forty-two patients presented with acute pancreatitis while 53 patients presented with exacerbation of their abdominal pain. Of these, 13 patients required mechanical lithotripsy and are the subject of this report. Nine of 13 patients had single stones (8-12 mm) while 3 of 13 patients had multiple stones (6-10 mm). Ducts were dilated in all patients (6-16 mm). RESULTS: Successful stone extraction required 1-3 (mean 1.8 sessions). Endoscopic sphincterotomy was performed in all patients. Single stones were extracted in 8 of 9 patients (89%), multiple stones in 3 of 4 patients (75%). PD stents were placed after initial attempts at extraction (=5)and palliation (=2). Of the 2 patients with unsuccessful stone extraction, 1 underwent pancreaticojejunostomy with good long-term results. Of the 2 patients with failed stone extraction, both were treated intermittently with stents with recurrent symptoms (mean follow-up 3.8 years). Nine of 11 patients had complete stone extraction with 8 of these patients with good long-term (no pain/pancreatitis) results and no recurrence (mean follow-up 4.2 years). CONCLUSION: Endoscopic removal of recalcitrant PD stones can be accomplished in the majority of pts by mechanical lithotripsy with good long-term outcome. Those failing endoscopic therapy will often respond to surgical options.

Long-term benefit after extracorporeal shockwave lithotripsy of pancreatic duct stones in patients with chronic pancreatitis

Long-term benefit after extracorporeal shockwave lithotripsy of pancreatic duct stones in patients with chronic pancreatitis

Mechanical lithotripsy of pancreatic duct stones

Mechanical lithotripsy of pancreatic duct stones

Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study.

Extracorporeal shock wave lithotripsy of pancreatic duct stones (largest stone 12 (SD) 6 mm) was performed in 24 patients with abdominal pain and a dilated duct system (main pancreatic duct 10 (3) mm). The procedure was well tolerated in all but two patients, who had a mild pancreatitic attack immediately after lithotripsy. Disintegration of the stones was achieved in 21 patients. This allowed complete clearance of the duct system by an endoscopic approach in 10 (42%) patients and partial clearance in 7 (29%) patients. Within a mean follow up period of 24 (14) months half of the patients showed complete or considerable relief of pain and alleviation of symptoms was achieved in seven patients. Relief of pain occurred more often after complete ductal clearance. There were no fatalities within the follow up period. These findings underline the value of a combined non-surgical approach, using endoscopy and adjuvant shock wave lithotripsy to patients with large pancreatic calculi and pain attacks.