SINGLE-OPERATOR VIDEO PANCREATOSCOPY (SOVP) FOR THE MANAGEMENT OF SYMPTOMATIC PANCREATIC DUCT STONES IN SELECTED CHRONIC PANCREATITIS PATIENTS. A PROSPECTIVE MULTICENTRE COHORT TRIAL

Aims SOVP-guided treatment of pancreatolithiasis offers an alternative to extracorporeal shock wave lithotripsy(ESWL) in patients with symptomatic chronic obstructive pancreatitis(SCOP). We present early results of a prospective evaluation of the efficacy, safety and clinical outcome of SOVP-guided lithotripsy.

Methods Between 2019-2021 patients with SCOP were enrolled in a prospective multicenter cohort study. The sample size calculation was based on the hypothesis of SOVP higher technical success over ESWL(Performance Goal of 74%). Primary endpoint was technical success defined as complete PD clearance within three SOVP sessions. Secondary endpoints included: clinical success, assessed by Izbicki pain score(IPS) improvement from baseline with complete/partial pain relief evaluation over time; incidence of adverse events(AE) reported in the follow-up; radiological PD diameter assessment before and 6 months after final SOVP.

Results We enrolled 40 patients with 1.7(±1.3)pancreatic stones, 8.4mm(±2.9)upstream PD diameter, and 55.3(±46.2)baseline IPS. SOVP achieved a complete stone clearance rate of 90.0%(36/40;p=0.011) with mean number of 1.33(STD0.62)SOVP-sessions. Pancreatic stents were placed in 88.7%(47/53) of the procedures for post-ERCP pancreatitis prophylaxis or treatment of associated strictures. Mild AE were registered in 7.5%(3/40)of the cases. At 6 months follow-up, the rate of residual stones was 0.0%(0/33), PD diameter decreased to 4.8mm±2.0 and IPS was 9.0±16.7 with complete pain relief/partial pain relief in the 66.7%(22/33)/21.2%(7/33).

Table 1

	Izbicki Pain Score	Change in Izbicki Pain Score From Baseline
Baseline	55.3±46.2(40)(0.0,303.8)(33.5,49.5,63.8)	NA
Final 30 Day Visit	23.6±23.8(23)(0.0,63.8)(0.0,20.8,48.3)	-30.9±24.5(23)(-76.7,0.0)(-50.5, -23.3,-11.3)
Final 3 Month Visit	17.3±22.9(34)(0.0,76.3)(0.0,0.0,25.8)	-42.9±47.3(34)(-272.1,6.3)(-50.0,-44.6,-17.5)
6 Month Visit	9.0±16.7(33)(0.0,76.3)(0.0,0.0,13.8)	-48.3±48.5(33)(-280.4,6.3)(-50.0,-45.5,-23.3)

Fig. 1

Conclusions SOVP-guided treatment of symptomatic PD stones is safe and achieves ductal clearance in 90% selected SCOP patients. Median-term results show pain relief in more than 2/3 cases. SOVP-guided lithotripsy is an effective alternative for ESWL for PD stones.

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Artikel online veröffentlicht:
14. April 2022