Tips for Using SpyGlass Peroral Pancreatoscopy and X-Ray-Guided Electrohydraulic Lithotripsy for Refractory Pancreatic Stones
Objective: Extracorporeal shock wave lithotripsy (ESWL) and endoscopic stone lithotomy (EL) are minimally invasive procedures that are useful for treating pancreatic stones. However, large-diameter and impacted stones can be refractory to these treatments. We retrospectively evaluated the efficacy of peroral pancreatoscopy (POPS) and X-ray-guided electrohydraulic lithotripsy (EHL) in treating refractory pancreatic stones. Methods: From May 2005 to April 2014, 159 chronic pancreatitis and pancreatic lithiasis patients were treated with ESWL and EL. EHL was performed as a second attempt for unsuccessful ESWL and EL cases. For refractory cases, we used the 10 Fr SpyGlass Direct Visualization System for POPS-guided EHL. X-ray-guided EHL (using a 7 Fr biliary dilator as an outer sheath) was performed when a 10 Fr SpyGlass system was difficult to insert into the main pancreatic duct. Results: A total of 18 patients were included in this study. The mean stone diameter was 12.3 ± 4.5 mm, with 7 patients having a single stone and 11 patients having multiple stones. POPS-guided EHL was performed in nine cases and X-ray-guided EHL was performed in nine cases. Fragmentation was successful in nine (50%) patients: four treated with POPS-guided EHL and five treated with X-ray-guided EHL. Two patients developed mild post-ERCP pancreatitis following X-ray-guided EHL. Conclusions: POPS-guided and X-ray-guided EHL may be an alternative treatment for refractory stones. Because EHL can cause severe complications, adequate precautions are necessary for these treatments.
KeywordsElectrohydraulic lithotripsy Pancreatic stones Peroral pancreatoscopy
We thank the paramedical, medical, and endoscopy staff at the Division of Gastroenterology and Hepatology of the Department of Internal Medicine, Toho University, for making this study possible.
Conflict of Interests: The authors declare no conflict of interests relevant to this article.
- 7.Ito K, Igarashi Y, Okano N, et al. Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis. Biomed Res Int. 2014;2014:732781. https://doi.org/10.1155/2014/732781.CrossRefPubMedPubMedCentralGoogle Scholar