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Ito K. et al., 2022: Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment.

Ito K, Okano N, Takuma K, Iwasaki S, Watanabe K, Kimura Y, Yamada Y, Yoshimoto K, Hara S, Kishimoto Y, Matsuda T, Igarashi Y.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.

Abstract

Background/aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones.

Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure.

Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation.

Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
Gut Liver. 2022 Dec 13. doi: 10.5009/gnl220204. Online ahead of print. PMID: 36510774. FREE ARTICLE

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Comments 1

Peter Alken on Thursday, 09 March 2023 09:30

This paper puts an exclamation mark behind the title.
The authors discuss the different results with the three devices: “A cylindrical system can output approximately 1.5 times more energy than a flat-type electromagnetic system. Second, SLX-F2 has a shock wave focal pressure range of 5 to 160 MPa, which is broader than that of Lithoskop (10 to 75 MPa), allowing it to handle various types of stones, from fragmentable ones to resistant ones. Third, SLXF2 has a compact focus size of 28×6 mm, which minimizes its impact on peripheral organs. These three characteristics may contribute to efficient lithotripsy of pancreatic stones. These considerations may explain the differences in fragmentation rates.”
Univariate and multivariate comparison did not compare identical parameters. I think a little bit more calculations would have given a clearer picture.

Peter Alken

This paper puts an exclamation mark behind the title. The authors discuss the different results with the three devices: “A cylindrical system can output approximately 1.5 times more energy than a flat-type electromagnetic system. Second, SLX-F2 has a shock wave focal pressure range of 5 to 160 MPa, which is broader than that of Lithoskop (10 to 75 MPa), allowing it to handle various types of stones, from fragmentable ones to resistant ones. Third, SLXF2 has a compact focus size of 28×6 mm, which minimizes its impact on peripheral organs. These three characteristics may contribute to efficient lithotripsy of pancreatic stones. These considerations may explain the differences in fragmentation rates.” Univariate and multivariate comparison did not compare identical parameters. I think a little bit more calculations would have given a clearer picture. Peter Alken
Thursday, 23 May 2024