TY - JOUR
T1 - ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis
T2 - A multicenter U.S. experience
AU - Attwell, Augustin R.
AU - Patel, Sandeep
AU - Kahaleh, Michel
AU - Raijman, Isaac L.
AU - Yen, Roy
AU - Shah, Raj J.
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: M. Kahaleh: Consultant for Boston Scientific and XLumina; research grant recipient from Boston Scientific, XLumena, MKT, MI Tech, Emcision, and Pinnacle. I. L Raijman: Speaker for Boston Scientific, Novartis, Conmed, Covidien, and Taheda; medical advisory board for Boston Scientific. R. J Shah: Medical advisory board for Boston Scientific; unrestricted educational grant from Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.
Publisher Copyright:
© 2015 American Society for Gastrointestinal Endoscopy.
Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background In patients with chronic pancreatitis, laser lithotripsy (LL) permits stone fragmentation and removal during ERCP with some advantages over extracorporeal shock-wave lithotripsy (ESWL) and surgery. Objectives To evaluate the technical success of LL in pancreatic duct (PD) stones. Design Retrospective cohort. Setting Four tertiary referral centers. Patients Patients undergoing endotherapy for PD stones. Interventions ERCP with per-oral pancreatoscopy (POP)-guided LL. Main Outcome Measurement Technical success was defined as complete stone clearance. Results Over 3 years, 28 patients (16 men, 51 years [mean age]) underwent a median of 1 (range, 1-4) POP-LL for PD stones. Baseline parameters included pain requiring hospitalization (n = 19, 68%), opiate use (n = 14, 50%), or weight loss (n = 11, 39%). Before POP-LL, 22 of 28 patients (79%) had a median of 1 (range, 1-5) ERCP, 9 of 28 (32%) underwent a median of 2 (range, 1-3) ESWL sessions, and 5 underwent a median of 1 (range, 1-3) POP-guided electrohydraulic lithotripsy with failed (n = 2) or partial (n = 3) fragmentation. A median of 2 (range, 1-3) stones sized 15 mm (range, 4-32 mm) were identified in the head (n = 9, 32%), neck (n = 3, 11%), body (n = 9, 32%), tail (n = 1, 4%), or multiple sites (n = 6, 21%). Technical success occurred in 22 patients (79%) with complete clearance. Partial clearance occurred in 3 (11%). Clinical success at a median of 13 (range, 1-25) months of follow-up was noted in 25 of 28 patients (89%) by improvement in pain (n = 25), decreased narcotic use (n = 25), or reduced hospitalizations (n = 19). Mild adverse events occurred in 8 of 28 (29%). Conclusions POP-LL is feasible at expert centers in patients with accessible stones. Although intensive endotherapy is required, most patients achieve stone clearance and clinical improvement.
AB - Background In patients with chronic pancreatitis, laser lithotripsy (LL) permits stone fragmentation and removal during ERCP with some advantages over extracorporeal shock-wave lithotripsy (ESWL) and surgery. Objectives To evaluate the technical success of LL in pancreatic duct (PD) stones. Design Retrospective cohort. Setting Four tertiary referral centers. Patients Patients undergoing endotherapy for PD stones. Interventions ERCP with per-oral pancreatoscopy (POP)-guided LL. Main Outcome Measurement Technical success was defined as complete stone clearance. Results Over 3 years, 28 patients (16 men, 51 years [mean age]) underwent a median of 1 (range, 1-4) POP-LL for PD stones. Baseline parameters included pain requiring hospitalization (n = 19, 68%), opiate use (n = 14, 50%), or weight loss (n = 11, 39%). Before POP-LL, 22 of 28 patients (79%) had a median of 1 (range, 1-5) ERCP, 9 of 28 (32%) underwent a median of 2 (range, 1-3) ESWL sessions, and 5 underwent a median of 1 (range, 1-3) POP-guided electrohydraulic lithotripsy with failed (n = 2) or partial (n = 3) fragmentation. A median of 2 (range, 1-3) stones sized 15 mm (range, 4-32 mm) were identified in the head (n = 9, 32%), neck (n = 3, 11%), body (n = 9, 32%), tail (n = 1, 4%), or multiple sites (n = 6, 21%). Technical success occurred in 22 patients (79%) with complete clearance. Partial clearance occurred in 3 (11%). Clinical success at a median of 13 (range, 1-25) months of follow-up was noted in 25 of 28 patients (89%) by improvement in pain (n = 25), decreased narcotic use (n = 25), or reduced hospitalizations (n = 19). Mild adverse events occurred in 8 of 28 (29%). Conclusions POP-LL is feasible at expert centers in patients with accessible stones. Although intensive endotherapy is required, most patients achieve stone clearance and clinical improvement.
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U2 - 10.1016/j.gie.2015.01.020
DO - 10.1016/j.gie.2015.01.020
M3 - Article
C2 - 25841585
AN - SCOPUS:84937515349
VL - 82
SP - 311
EP - 318
JO - Gastrointestinal Endoscopy
JF - Gastrointestinal Endoscopy
SN - 0016-5107
IS - 2
ER -