Electrohydraulic Lithotripsy Safe and Effective for Clearing Obstructive Pancreatic Stones Near the Duodenum
Bret T. Petersen, MD, MASGE, reviewing van der Wiel SE, et al. Gastrointest Endosc 2021 Dec 11.
Electrohydraulic lithotripsy (EHL) and laser lithotripsy are both well-established methods for the treatment of biliary and genitourinary stones. Several retrospective series have described successful pancreatoscopy-guided EHL for intraductal stones in symptomatic chronic pancreatitis.
In this prospective, single-center, consecutive case series, the authors report the efficacy and safety for EHL used as first-line therapy for 34 patients with main pancreatic duct stones >5 mm in size located in the head or neck of the gland. Prior pancreatoscopy and stent placement were pursued in all patients; 3 preparatory procedures yielded stone clearance without EHL (9%), and 5 failed to access the pancreatic duct (15%).
Partial or complete fragmentation was achieved in 24 of 31 patients (77%) and 24 of 26 (92.3%) of those successfully cannulated. A median of 2 ERCPs (interquartile range [IQR], 2) and 1 EHL (IQR, 1) yielded partial stone clearance in 5 patients (20%) and complete clearance in 20 (80%). Mild acute pancreatitis occurred in 7 patients and was conservatively treated in all. Izbicki pain scores declined significantly from 62.3 ± 23.1 (n=25/25) to 27.5 ± 35.0 (22/25) at the 6-month assessment.
COMMENTThis report confirms the reasonable success and safety of pancreatoscopy and EHL for the clearance of intraductal-obstructing pancreatic stones when they are within reach of the duodenum. The ready availability of single-operator cholangioscopy and pancreatoscopy in advanced endoscopy suites makes delivery of intraductal fragmentation relatively widely accessible, perhaps more so than is the current standard – extracorporeal shockwave lithotripsy. Pancreatoscopy for endoscopic lithotripsy is more challenging than cholangioscopy, however, and those symptomatic stones in the body, tail, or side branches are often inaccessible.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
van der Wiel SE, Stassen PMC, De Jong DM, Poley JW, de Jonge PJF, Bruno MJ. Pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones in the head and neck of the pancreas: a prospective consecutive case series. Gastrointest Endosc 2021 Dec 11. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.11.047)
