Per‐oral pancreatoscopy‐guided lithotripsy for the endoscopic management of pancreatolithiasis: A systematic review and meta‐analysis

Abstract

Objective Pancreatic stones result from chronic pancreatitis and can occur in the main pancreatic duct, pancreatic branches or parenchyma. Although extracorporeal shock wave lithotripsy (ESWL) is considered the first‐line treatment, per‐oral pancreatoscopy (POP) has emerged as a useful method for treating pancreatic stones. The aim of this systematic review and meta‐analysis was to determine the efficacy and safety of POP‐guided lithotripsy, electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL), in patients with pancreatolithiasis. Methods Literature review was conducted in PubMed, OVID, MEDLINE and Cochrane Library databases for studies published up to August 2020. Results Altogether 15 studies were analyzed, of which 11 were retrospective and four were prospective. The studies comprised 370 patients, of whom 66.4% were male. The patients underwent 218 EHL and 155 LL. The pooled technical and clinical success rate of the overall POP was 88.1% and 87.1%. For EHL‐POP, the pooled technical success rate was 90.9% (95% CI 87.2%‐95.2%) and the pooled clinical success rate was 89.8% (95% CI 87.2%‐95.2%). While for LL‐POP, the pooled technical and clinical success rate was 88.4% (95% CI 85.9%‐95.1%) and 85.8% (95% CI 80.6%‐91.6%). In total 43 adverse events occurred (12.1%; 95% CI 8.7%‐15.5%). Conclusion POP‐guided lithotripsy has a high rate of technical and clinical success for managing pancreatolithiasis with a low complication rate. Both EHL‐POP and LL‐POP achieve similar efficacy in the endoscopic therapy of pancreatolithiasis. Further large randomized controlled trials are needed to compare EHL‐POP and LL‐POP with ESWL and evaluate whether POP may replace ESWL as the first‐line management of pancreatolithiasis.

Electrohydraulic lithotripsy through endoscopic retrograde cholangiopancreatography combined with SpyGlass in the treatment of complex pancreatic duct stones: A case report and literature review

“…While for LL-POP, the pooled technical and clinical success rate was 88.4% (95% CI 85.9%–95.1%) and 85.8% (95% CI 80.6%–91.6%). In total, 43 adverse events occurred (12.1%;95% CI 8.7%–15.5%) ( 30 ). Another recent meta-analysis of pancreatic duct stone management by McCarty et al showed that in 302 patients, Pooled technical success was 91.18%, with an overall fragmentation success of 85.77%.…”

Experiencia en colangioscopia digital peroral con SpyGlass DS en diferentes centros de referencia en gastroenterología y endoscopia digestiva en Colombia: Serie de casos

“…Mientras que, al comparar entre LHE y láser, los resultados son diversos en relación al sitio de presencia de litos, por un lado, en el metaanálisis de Veld et al, en el que se incluyeron 32 estudios, y que en su mayoría se consideró cálculos biliares en el colédoco, se encontró que la litotricia laser fue superior a EHL, al mostrar mayor tasa de eliminación de cálculos (95,1% frente a 88,4%, respectivamente), y menores tasas de complicaciones post-procedimentales (8,4% vs. 13,8%, respectivamente) (22) . Por el otro, en un metaanálisis reciente, en el que se incluyeron 15 estudios, en sujetos con pancreatolitiasis, Guzmán-Calderón et al encontraron tasa de éxito clínico de LHE del 91,6%, y para laser de 86,6%, y la tasa de eventos adversos fue 12% (23) .…”

Cholangioscopy: Has It Changed Management?

“…Adverse events occurred in 12%. 19 The role of intraductal lithotripsy in management of patients with chronic pancreatitis is unclear. Further studies with a head-to-head comparison between ESWL and intraductal lithotripsy may help better define its role.…”