Bick BL. et al., 2021: A comparative study between single-operator pancreatoscopy with intraductal lithotripsy and extracorporeal shock wave lithotripsy for the management of large main pancreatic duct stones.
Bick BL, Patel F, Easler JJ, Tong Y, Watkins JL, McHenry L, Lehman G, Fogel EL, Gromski MA, Sherman S.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 University Blvd, Suite UH1602, Indianapolis, IN, USA.
Department of Internal Medicine and Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 550 University Blvd, Suite UH1602, Indianapolis, IN, USA.
Department of Biostatistics, Indiana University School of Public Health, Indianapolis, IN, USA.
Background and aims: Endoscopic management of large main pancreatic ductal (MPD) stones often require treatment with lithotripsy. Extracorporeal shock wave lithotripsy (ESWL) has been the mainstay therapy, and single-operator pancreatoscopy with intraductal (intracorporeal) lithotripsy (SOPIL) is an emerging technique. However, no comparative studies between these techniques exist. We therefore aimed to compare ESWL to SOPIL for the treatment of large MPD stones.
Methods: This is a retrospective cohort study comparing patients who were treated with ESWL or SOPIL from September 2013 to September 2019 at a single tertiary center. Logistic regression was performed to identify factors associated with technical success and efficient stone clearance (≤ 2 procedures to clear stones).
Results: There were 240 patients who were treated with ESWL and 18 treated with SOPIL. The overall technical success rate of stone clearance was 224/258 (86.8%), which was similar between the ESWL and SOPIL groups (86.7% vs 88.9%, p = 1.000). A SOPIL approach required fewer total procedures (1.6 ± 0.6 vs 3.1 ± 1.5, p < 0.001) and less aggregate procedure time (101.6 ± 68.2 vs 191.8 ± 111.6 min, p = 0.001). Adverse event rates were similar between the groups (6.3% vs 5.6%, p = 1.000). The use of SOPIL was independently associated with greater efficiency compared to ESWL (OR 5.241 [1.348-20.369], p = 0.017). Stone size > 10 mm was associated with less efficient stone clearance (OR 0.484 [0.256-0.912], p = 0.025).
Conclusion: Both ESWL and SOPIL are safe and effective endoscopic adjunct modalities for treating large pancreatic duct stones. SOPIL is an emerging alternative to ESWL that is potentially more efficient for lithotripsy and MPD stone clearance.
Surg Endosc. 2021 Jul 15. doi: 10.1007/s00464-021-08631-7. Online ahead of print. PMID: 34264399
Comments 1
Gastroenterologists still seem to live on a planet that Urologist are leaving. 224 ESWL vs. only 18 patients treated with the endoscopic SOPIL using electrohydraulic lithotripsy in a 6 years’ time period between 2013 and 2019. This is unfortunately a retrospective, non-randomized study. The physicians determined which treatment was used. However, there is a recent retrospective multicentre-study confirming the positive results with the endoscopic approach (1). 109 patients in 17 centres in the US and Europe in a 20 months period between 2015 and 2017 is not a big number. Who was pushing this latter open access publication from 17 departments and 40 authors? Every department is on the payroll of some company involved in the technology.
Peter Alken