ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience.

Abstract

BACKGROUND:

In patients with chronic pancreatitis, laser lithotripsy (LL) permits stone fragmentation and removal during ERCP with some advantages over extracorporeal shock-wave lithotripsy (ESWL) and surgery.

OBJECTIVES:

To evaluate the technical success of LL in pancreatic duct (PD) stones.

DESIGN:

Retrospective cohort.

SETTING:

Four tertiary referral centers.

PATIENTS:

Patients undergoing endotherapy for PD stones.

INTERVENTIONS:

ERCP with per-oral pancreatoscopy (POP)-guided LL.

MAIN OUTCOME MEASUREMENT:

Technical success was defined as complete stone clearance.

RESULTS:

Over 3 years, 28 patients (16 men, 51 years [mean age]) underwent a median of 1 (range, 1-4) POP-LL for PD stones. Baseline parameters included pain requiring hospitalization (n=19, 68%), opiate use (n=14, 50%), or weight loss (n=11, 39%). Before POP-LL, 22 of 28 patients (79%) had a median of 1 (range, 1-5) ERCP, 9 of 28 (32%) underwent a median of 2 (range, 1-3) ESWL sessions, and 5 underwent a median of 1 (range, 1-3) POP-guided electrohydraulic lithotripsy with failed (n=2) or partial (n=3) fragmentation. A median of 2 (range, 1-3) stones sized 15 mm (range, 4-32 mm) were identified in the head (n=9, 32%), neck (n=3, 11%), body (n=9, 32%), tail (n=1, 4%), or multiple sites (n=6, 21%). Technical success occurred in 22 patients (79%) with complete clearance. Partial clearance occurred in 3 (11%). Clinical success at a median of 13 (range, 1-25) months of follow-up was noted in 25 of 28 patients (89%) by improvement in pain (n=25), decreased narcotic use (n=25), or reduced hospitalizations (n=19). Mild adverse events occurred in 8 of 28 (29%).

CONCLUSIONS:

POP-LL is feasible at expert centers in patients with accessible stones. Although intensive endotherapy is required, most patients achieve stone clearance and clinical improvement.

• Authors: Augustin R Attwell, Sandeep Patel, Michel Kahaleh, Isaac L Raijman, Roy Yen, Raj J Shah
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 82 Issue 2 Pg. 311-8 (Aug 2015) ISSN: 1097-6779 [Electronic] United States
• PMID: 25841585 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid

Topics

• Abdominal Pain (drug therapy, etiology)
• Adolescent
• Adult
• Aged
• Analgesics, Opioid (therapeutic use)
• Calculi (complications, diagnostic imaging, therapy)
• Cholangiopancreatography, Endoscopic Retrograde (adverse effects, methods)
• Female
• Humans
• Lithotripsy, Laser (adverse effects)
• Male
• Middle Aged
• Pancreatic Ducts
• Pancreatitis, Chronic (etiology, therapy)
• Treatment Outcome
• United States
• Young Adult