Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

Abstract

BACKGROUND Pancreatic duct stones can lead to significant abdominal pain for patients. Per oral pancreatoscopy (POP)-guided intracorporal lithotripsy is being increasingly used for the management of main pancreatic duct calculi (PDC) in chronic pancreatitis. POP uses two techniques: Electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL). Data on the safety and efficacy are limited for this procedure. We performed a systematic review and meta-analysis with a primary aim to calculate the pooled technical and clinical success rates of POP. The secondary aim was to assess pooled rates of technical success, clinical success for the two individual techniques, and adverse event rates. AIM To perform a systematic review and meta-analysis of POP, EHL and LL for management of PDC in chronic pancreatitis. METHODS We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Cochrane, Google Scholar and Web of Science databases (from 1999 to October 2019) to identify studies with patient age greater than 17 and any gender that reported on outcomes of POP, EHL and LL. The primary outcome assessed involved the pooled technical success and clinical success rate of POP. The secondary outcome included the pooled technical success and clinical success rate for EHL and LL. We also assessed the pooled rate of adverse events for POP, EHL and LL including a subgroup analysis for the rate of adverse event subtypes for POP: Hemorrhage, post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), perforation, abdominal pain, fever and infections. Technical success was defined as the rate of clearing pancreatic duct stones and clinical success as the improvement in pain. Random-effects model was used for analysis. Heterogeneity between study-specific estimates was calculated using the Cochran Q statistical test and I 2 statistics. Publication bias was ascertained, qualitatively by visual inspection of funnel plot and quantitatively by the Egger test. RESULTS A total of 16 studies including 383 patients met the inclusion criteria. The technical success rate of POP was 76.4% (95%CI: 65.9-84.5; I 2 = 64%) and clinical success rate was 76.8% (95%CI: 65.2-85.4; I 2 = 66%). The technical success rate of EHL was 70.3% (95%CI: 57.8-80.3; I 2 = 36%) and clinical success rate of EHL was 66.5% (95%CI: 55.2-76.2; I 2 = 19%). The technical success rate of LL was 89.3% (95%CI: 70.5-96.7; I 2 = 70%) and clinical success rate of LL was 88.2% (95%CI: 66.4-96.6; I 2 = 77%). The incidence of pooled adverse events for POP was 14.9% (95%CI: 9.2-23.2; ...

Endoscopic management of chronic pancreatitis

“…Complete ductal clearance and clinical success was achieved in 70% and 74% patients, respectively 25 . Favorable results with intraductal lithotripsy have been reproduced in several other studies and reviews published subsequently 26–34 . In a recent review, the pooled technical success and overall fragmentation success were 91.2% and 85.8%, respectively 33 .…”

“…25 Favorable results with intraductal lithotripsy have been reproduced in several other studies and reviews published subsequently. [26][27][28][29][30][31][32][33][34] In a recent review, the pooled technical success and overall fragmentation success were 91.2% and 85.8%, respectively. 33 Stone fragmentation and ductal clearance in a single session could be achieved in 62% of patients.…”

“…The most commonly reported adverse event was post-ERCP pancreatitis (7%) followed by pain (4.7%), perforation (4.3%), and hemorrhage (3.4%). 34 There are several potential advantages of POP-guided lithotripsy. POP allows stones to be targeted under direct visualization, which potentially reduces ductal injuries.…”

Percutaneous Transhepatic Electrohydraulic Lithotripsy for the Treatment of Difficult Bile Stones

“…The electrohydraulic lithotripsy (EHL) technique uses a charge generator and a bipolar probe to create a spark to produce a vapor plasma. The vapor plasma becomes a cavitation bubble that oscillates around the tip of the probe, which leads to stone fragmentation by absorption of rebounding shockwaves from the vapor [ 4 ].…”

The first case of pancreatoscopy-guided lithotripsy using a novel superpulsed fiberoptic thulium laser

“…The postoperative period was uneventful, and the patient was discharged on the third day after the intervention. Currently, there are three main methods of treatment for MPD stones: extracorporeal shock wave lithotripsy, electrohydraulic lithotripsy, and holmium laser lithotripsy [1][2][3]. A recently released super-pulsed fiberoptic thulium laser has been shown since 2019 to be highly effective in lithotripsy of ureteral stones [4].…”