CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(07): E896-E903
DOI: 10.1055/a-0889-7743
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Safety and efficacy of digital single-operator pancreatoscopy for obstructing pancreatic ductal stones

Olaya I. Brewer Gutierrez
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Isaac Raijman
 2   Greater Houston Gastroenterology, Texas, United States
,
Raj J. Shah
 3   Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
,
B. Joseph Elmunzer
 4   Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
,
George J.M. Webster
 5   University College London Hospitals, London, UK
,
Douglas Pleskow
 6   Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Stuart Sherman
 7   Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
,
Richard P. Sturgess
 8   Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
,
Divyesh V. Sejpal
 9   Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
,
Christopher Ko
10   Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
,
Attilio Maurano
11   University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
,
Douglas G. Adler
12   Division of Gastroenterology and Hepatology University of Utah School of Medicine, Utah, United States
,
Daniel K. Mullady
13   Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
,
Daniel S. Strand
14   Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
,
Christopher J. DiMaio
15   Division of Gastroenterology Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, United States
,
Cyrus Piraka
16   Henry Ford Hospital, Detroit, Michigan, United States
,
Reem Sharahia
17   Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
,
Mohamad H. Dbouk
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Samuel Han
 3   Division of Gastroenterology and Hepatology University of Colorado-Denver Medical School, Colorado, United States
,
Clayton M. Spiceland
 4   Division of Gastroenterology and Hepatology. Medical University of South Carolina, Charleston, South Carolina, United States
,
Noor L.H. Bekkali
 5   University College London Hospitals, London, UK
,
Moamen Gabr
 6   Division of Gastroenterology and Hepatology Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Benjamin Bick
 7   Division of Gastroenterology and Hepatology Indiana University Medical Center, Indiana, United States
,
Laura K. Dwyer
 8   Division of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, United Kingdom
,
Dennis Han
 9   Division of Gastroenterology and Hepatology Hofstra-Northwell School of Medicine, New York, United States
,
James Buxbaum
10   Division of Gastroenterology and Hepatology University of Southern California Keck School of Medicine, California, United States
,
Claudio Zulli
11   University Hospital of Salerno, G. Fucito Center, Mercato San Severino (SA), Italy
,
Natalie Cosgrove
13   Division of Gastroenterology and Hepatology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, United States
,
Andrew Y. Wang
14   Division of Gastroenterology and Hepatology University of Virginia Health System, Virginia, United States
,
David Carr-Locke
17   Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
,
Tossapol Kerdsirichairat
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Hanaa Dakour Aridi
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Robert Moran
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Shawn Shah
17   Division of Gastroenterology and Hepatology Weil Cornell, New York, New York, United States
,
Juliana Yang
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Omid Sanaei
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Nasim Parsa
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Vivek Kumbhari
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Vikesh K. Singh
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
,
Mouen A. Khashab
 1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Maryland United States
› Author Affiliations
Further Information

Publication History

Publication Date:
03 July 2019 (online)

Abstract

Background and study aims The role of the digital single-operator pancreatoscopy (D-SOP) with electrohydraulic (EHL) or laser lithotripsy (LL) in treating pancreatic ductal stones is unclear. We investigated the safety and efficacy of D-SOP with EHL or LL in patients with obstructing pancreatic duct stones.

Patients and methods Retrospective analysis of 109 patients who underwent D-SOP for pancreatic stones at 17 tertiary centers in the United States and Europe from February 2015 to September 2017. Logistic regression was performed to identify factors associated with the need for more than one D-SOP with EHL/LL.

Results Most patients were males (70.6 %),mean age 54.7 years. Fifty-nine (54.1 %) underwent EHL and 50 (45.9 %) underwent LL. Mean procedure time was longer in the EHL group (74.4 min vs 53.8 min; P < 0.001). Ducts were completely cleared (technical success) in 89.9 % of patients (94.1 % in EHL vs 100 % in LL; P = 0.243), achieved in a single session in 73.5 % of patients (77.1 % by EHL and 70 % by LL; P= 0.5).D-SOP failed in 11 patients (10.1 %); 6 patients were treated with extracorporeal shockwave lithotripsy (ESWL), 1 with surgery,1 with combined treatment (ESWL + D-SOP EHL) and 3 with other. Fourteen adverse events occurred in 11 patients (10.1 %). Patients with more than three ductal stones were more likely to have technical failure compared to those with less than three stones (17 % vs. 4.8 %; P = 0.04). Having more than three stones was independently associated with the need for more than one D-SOC EHL/LL session (OR 2.94, 95 % CI 1.13 – 7.65).

Conclusion D-SOP with EHL or LL is effective and safe in patients with pancreatic ductal stones.