Digital Single-Operator Pancreatoscopy Guided Laser Lithotripsy of Symptomatic Pancreatic Ductal Stones: A Single Centre Care Experience

Aims Chronic calcific pancreatitis (CCP) is common cause of chronic abdominal pain. Pancreatic endotherapy is effective modality for symptomatic main pancreatic duct (MPD) calculi. Large MPD calculi (≥5 mm) may require additional therapy including extra-corporeal shock wave lithotripsy (ESWL), mechanical, laser or electrohydraulic lithotripsy (EHL). Few studies have reported effectivity of digital single operator pancreatoscopy (DSOP) guided EHL for MPD calculi. In this study, we aimed to evaluate the efficacy and safety of DSOP guided laser lithotripsy for symptomatic MPD calculi.

Methods Data of patients who underwent DSOC guided laser lithotripsy for symptomatic MPD calculi were included from February 2020 – December 2022. Endoscopic reterograde pancreatography was performed, and DSOP (Spy glass DS, Boston Scientific Corp., Massachusetts, USA) was passed through duodenoscope and laser lithotripsy was performed (Figure 1 A-F). The primary end point was complete stone clearance (CSC). Secondary end points were MPD decompression, improvement in pain measured with the visual analogue score (VAS), technical failure and adverse events (AEs).

Results A total 15 [ Median age 32 (12-75), male; 10] CCP patients underwent DSOC guided laser lithotripsy (Table 1). A CSC was achieved in 11 (73.3%) patients and MPD decompression was achieved in 13 (86.7%) patients. Overall pain relief was achieved in 12 (80%) at 6 months of follow- up, with complete pain relief in 9 (60%) and partial pain relief in 3(20%) Patients. Technical failure was seen in 2 (13.3%) patients. In 1 patient because of head stricture, pancreatoscope could not be passed and he underwent surgery and another patient had persistent pain after partial PD clearance, so he underwent ESWL. AEs are seen in 4 (33.3%) patients and there were no severe AE’s seen.

Conclusions DSOP-guided endotherapy is safe and effective in selected patients with symptomatic MPD calculi. It significantly reduces pain and could be considered as an alternative to other ERP techniques and lithotripsy.

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Artikel online veröffentlicht:
15. April 2024