Keisuke Iwata et al., 2024: Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study
Keisuke Iwata 1 , Takuji Iwashita 2 , Tsuyoshi Mukai 3 , Yuhei Iwasa 1 , Mitsuru Okuno 1 , Kensaku Yoshida 4 , Akinori Maruta 4 , Shinya Uemura 2 , Ichiro Yasuda 5 , Masahito Shimizu 2
1Department of Gastroenterology, Gifu Municipal Hospital, Gifu 500-8513, Japan.
2First Department of Internal Medicine, Gifu University, Gifu 501-1194, Japan.
3Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa 920-0293, Japan.
4Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu 500-8717, Japan.
5Third Department of Internal Medicine, Graduate School of Medicine University of Toyama, Toyama 930-0194, Japan.
Abstract
Background: Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for pancreatic stones in chronic pancreatitis. In contrast, peroral pancreatoscopy-guided lithotripsy (POPS-L) remains underexplored, with limited comparative studies to ESWL. This study compared the treatment outcomes of disposable POPS-L tools and ESWL for pancreatic stones.
Methods: A retrospective analysis was conducted on 66 patients who had undergone pancreatic stone treatment at three institutions between 2006 and 2022. The treatment outcomes of POPS-L and ESWL were compared.
Results: This study included 19 and 47 patients who had undergone POPS-L and ESWL, respectively. In a comparison between POPS-L and ESWL, the stone clearance rates were 78.9% vs. 70.2% (p = 0.55), while the procedure-related complication rates were 21% vs. 6.3% (p = 0.09). The median total session counts were 1 vs. 5 (p < 0.01). The cumulative stone recurrence rates were comparable in both groups. Multivariate analysis revealed no significant factors influencing the stone clearance rates, and the choice between POPS-L and ESWL did not affect the stone clearance rates.
Conclusions: POPS-L and ESWL exhibited comparable treatment outcomes in terms of stone clearance, complications, and recurrence rates. Furthermore, POPS-L is advantageous due to the need for fewer sessions to achieve pancreatic stone clearance.
Diagnostics (Basel). 2024 Apr 24;14(9):891. doi: 10.3390/diagnostics14090891. PMID: 38732306
PMCID: PMC11082964
Comments 1
This article on treatment of pancreatic duct stones might be of limited interest in a urological perspective. But it is well recognized that urologists commonly are involved in the treatment of these patients, because urologists very often are responsible for the lithotripter service.
The message in this report is important because the authors compared endoscopy (n=19) and SWL (n=47) with clearance of 78.9 and 70.2 %, respectively. Both groups were treated with sphincterotomy. Moreover, stenting or other kinds of biliary drainage were carried out. All treatments were completed with the patient in prone position.
The number of re-treatments was considerably higher for SWL, but it is also important to note that the size range of stones was larger in patients treated with SWL.
In my own experience SWL-success can be expected in patients with brittle calcium carbonate stones also without stents, catheters or sphincterotomy. I cannot see if all SWL-sessions were carried out with general anesthesia although this seems likely. However, in the reviewer’s experience, general anesthesia is far from always necessary.
Hans-Göran Tiselius