International multicenter study on digital single operator pancreatoscopy for the management of pancreatic stones.
Brewer Gutierrez OI, Raijman I, Shah RJ, Joseph Elmunzer B, Webster G, Pleskow DK, Sherman S, Sturgess R, Sejpal DV, Ko C, Maurano A, Adler DG, Mullady D, Strand DS, DiMaio CJ, Piraka C, Sharaiha RZ, Dbouk M, Han S, Spyceland C, Bekkali N, Gabr M, Bick BL, Dwyer LK, Han D, Buxbaun J, Zulli C, Cosgrove N, Wang AY, Carr-Locke DL, Kerdsirichairat T, Aridi H, Moran R, Shah S, Yang J, Sanaei O, Parsa N, Kumbhari V, Singh V, and Khashab MA. International multicenter study on digital single operator pancreatoscopy for the management of pancreatic stones. Gastrointest Endosc 2018; 87(6):AB68-AB69.
Background: The role of the digital single-operator cholangioscopy (D-SOC) system for the treatment of pancreatic ductal (PD) stones in patients with chronic pancreatitis (CP), using electrohydraulic (EHL) and laser lithotripsy (LL), is not well known. Aims: (1)To study the technical success (complete ductal clearance) and safety (rate/ severity of adverse events (AE) per ASGE lexicon) of D-SOC system with EHL/LL in the treatment of pancreatic stones;(2)To compare the performance of EHL vs. LL. Methods: International, multicenter, retrospective study at 17 tertiary centers between 02/2015 and 09/2017. All patients who underwent D-SOC with EHL/LL for the treatment of PD stones were included. Logistic regression analysis was performed to identify factors associated with technical failure and the need for more than one D-SOC EHL/LL session. Results: 103 (30% F, mean age 54 yr.) patients were included. Most frequent cause of CP was alcohol (60%), 96% had abdominal pain, 49% diabetes, 77% were on narcotics and 45% on pancreatic enzymes. Overall, 12% of patients had previous extracorporeal shock wave lithotripsy (ESWL), 87% previous failed ERCP attempts to clear the PD, and 67% prior indwelling stents. Location of stones was: head 51%, neck 22%, body 15%, tail 4%, and multifocal 8%. The mean main PD diameter was 9.19±3.17 mm. A total of 59 patients were treated with EHL and 44 with LL. The mean procedure time was 64.2±23.2 min. Technical success was achieved in 92 (89%) patients, in a single session in 69 (75%) of patients, whereas 20 (21.7%) required 2-3 sessions and only 3 (3.3%) required more than 3 sessions. A total of 11 (11%) patients failed EHL/LL and were treated with ESWL (n=6), surgery (n=1), combined treatment (n=1) or other (n=3). Nine (8.7%) AEs occurred, 3 pancreatitis, 3 abdominal pain, 1 pancreatic duct perforation, 1 fever and 1 bleeding (mild 6 and moderate 3). Incomplete pancreatic stone removal/stone recurrence occurred in 7 (8%) patients during a median follow-up time of 214 days (IQR 66-403). Technical success was significantly higher in the LL group (81% vs 100%,p=0.002) and procedure time was shorter (55min vs. 74min, p<0.001). AEs (8% vs 9%,pZ1) were similar between the two groups. On univariable analysis, the only factor associated with technical failure was the presence of a PD stricture (OR 3.68 (1.00-13.47),p=0.05). There were no significant predictors of the need for more than one D-SOC EHL/LL on logistic regression analysis Conclusion: D-SOC using EHL or LL is highly effective and safe in treating PD stones, although LL appears to be more effective and efficient when compared to EHL. Only a minority of patients will require additional treatment with ESWL or surgery to achieve ductal clearance. This is the first large multicenter study on D-SOC for PD stones and suggests its major role in the treatment of PD stones.