Digital-Single-Operator Pancreatoscopy Guided Lithotripsy for Pancreatic Duct Stones In Symptomatic, Treatment Refractory Chronic Pancreatitis. Long-Term Follow-Up on Clinical, Technical Success and Quality of Life

Aims Pancreatic duct(PD) stones in patients with chronic calcifying pancreatitis(CCP) often contribute to pain and have a negative impact on quality of life(QOL). Therefore pancreatic duct clearance and drainage is the main goal in surgical and interventional therapy strategies. Digital-single-operator-video-pancreatoscopy (d-SOVP) guided lithotripsy was shown to achieve very high technical and clinical success rates(95 %) in a short-term follow-up. However, there is only little evidence of long-term success or impact on quality of life.

Methods Retrospective analysis of all d-SOVP guided lithotripsies(n = 23) between 2015 and 2017 in 20 CCP patients. Persistence of technical success(ductal clearance) and clinical success(defined as pain reduction >50 % in numerical rating scale NRS) as well as post interventional QOL was determined by a systematic questionnaire(based on SF-12) regarding pain intensity and incidence, painkiller intake and impact on QOL after 3, 6, 12, 30 months in an ongoing follow up.

Results After 32-57 months(m=41 months) 80 %(12 of 15) patients reported a significant decrease in pain and clinical symptoms(Mean NRS decreased from 6.1[±0.55] to 1.7[± 0.46], P<0.01; 80 % clinical success rate). There was no need for further interventional therapy except of subsequent stenting in cases of persistent PD strictures(n = 4). Three patients(20 %) reported persistent pain, 2 of them were referred for partial pancreatectomy and only one was pain-free after surgery. Regarding quality of life 80 % of the patients described major improvements in their general health status and everyday life performance. Two patients were lost to follow-up, 3 patients died during follow up(mean age 76).

Conclusions D-SOVP guided lithotripsy is safe and effective, leading to a high ductal clearance and good clinical outcome. Beneficial effects on symptom control and quality of life seem to be persistent in the majority of CCP patients after a median 41 months follow-up, even in this selective, pre-treated patient group and are comparable to published ESWL results.

Citation: Gerges C, Dertmann T, Schneider M et al. OP168 DIGITAL-SINGLE-OPERATOR PANCREATOSCOPY GUIDED LITHOTRIPSY FOR PANCREATIC DUCT STONES IN SYMPTOMATIC, TREATMENT REFRACTORY CHRONIC PANCREATITIS. LONG-TERM FOLLOW-UP ON CLINICAL, TECHNICAL SUCCESS AND QUALITY OF LIFE. Endoscopy 2021; 53: S68.

Publication History

Article published online:
19 March 2021