Endo S. et al., 2023: Extracorporeal shock wave lithotripsy and endoscopic pancreatic stenting without pancreatic sphincterotomy for the treatment of pancreatolithiasis: a case series.
Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-Ando, Aoi-Ku, Shizuoka-City, Shizuoka, 420-8527, Japan.
Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-Ando, Aoi-Ku, Shizuoka-City, Shizuoka, 420-8527, Japan.
Abstract
Endoscopic therapy and extracorporeal shock wave lithotripsy (ESWL) are recommended as the first choice in treating pancreatolithiasis. Endoscopic therapy is generally performed using endoscopic pancreatic sphincterotomy (EPST). Herein, we report our experience implementing a treatment protocol, combining endoscopic therapy and ESWL without EPST, for pancreatolithiasis. The inpatient treatment plan was performed every 3 months with a set number of sessions of ESWL with endoscopic pancreatic stenting (EPS) implanted or replaced. Finally, treatment was terminated when the stone was removed after implantation of a 10-Fr stent and crushed to approximately 3 mm or after spontaneous stone discharge. Eight patients were included in this study; the median time to stone disappearance was 208.5 days. The median number of inpatient treatment cycles, endoscopic retrograde cholangiopancreatography, and ESWL sessions was 2.5, 3, and 3, respectively. No serious adverse events were observed in all patients. Therefore, combining ESWL and EPS without EPST can safely treat pancreatolithiasis.
Clin J Gastroenterol. 2023 Apr 23. doi: 10.1007/s12328-023-01803-z. Online ahead of print.PMID: 37087534
Comments 1
8 cases without EPST in a 3 ½ year period are described. According to the authors the treatment has not been reported before. Obviously, it is a highly selected patient group evaluated in a retrospective study. Although the authors state that these are the results of implementing a treatment protocol, they do not elaborate on the selection criteria and it is not clear how many cases in their hands failed early on without making it into the study. The technique reminds me of trials to correct strictured ureters with stenting only. Failure or success were unpredictable.
Peter Alken