Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(03): E296-E304
DOI: 10.1055/a-2035-8969
Original article

Long-term outcomes of pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones

Florence E.M. de Rijk
1   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Pauline M.C. Stassen
1   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
2   Department of Research and Development, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Sophia E. van der Wiel
1   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Marja A. Boermeester
3   Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
4   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
,
Yama Issa
3   Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
4   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
,
Marinus A. Kempeneers
3   Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands
4   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
,
Robert C. Verdonk
5   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
,
Marco J. Bruno
1   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
,
Pieter Jan F. de Jonge
1   Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
› Author Affiliations TRIAL REGISTRATION: Long-term FU of a prospective single-center consecutive case series NTR6853 at ClinicalTrials.gov (http://www.clinicaltrials.gov/)
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Pancreatoscopy-guided electrohydraulic lithotripsy (EHL) has proven to be an effective first-line therapy in symptomatic chronic pancreatitis (CP) patients with obstructing pancreatic duct (PD) stones [1]. However, long-term outcomes of endoscopic EHL remain unknown. The aim of the present study was to evaluate the long-term treatment effects of EHL as first-line therapy and to compare with those obtained in a historical cohort of patients who underwent extracorporeal shockwave lithotripsy (ESWL) as primary treatment.

Patients and methods An observational retrospective single-center long-term follow-up study was performed including 19 consecutive patients who previously underwent endoscopic EHL compared to 18 patients who underwent ESWL followed by endoscopic retrograde pancreatography (ERP). The primary endpoint was long-term treatment success after EHL or ESWL defined as no recurrence of symptomatic intraductal stones confirmed on imaging. Secondary endpoints for the EHL-population included long-term clinical success (i. e., a similar or lower Izbicki Pain Score or reduction in opiate usage as compared to 6-month follow-up), quality of life (QoL), pancreatic function and hospital re-admission rate.

Results In the EHL group, 37 % of the patients developed recurrent symptomatic PD stones versus 61 % in the ESWL group after a median follow-up of 35.0 and 76.5 months. Of the patients with recurrence, 71 % versus 100 % underwent a reintervention. Median time to recurrence was 12.0 versus 13.0 months. Clinical success sustained in 58 % of the EHL patients. QoL was not significantly different compared with 6-month follow-up and baseline.

Conclusions Also at long-term follow-up, endoscopic EHL as first-line treatment is moderately effective for symptomatic CP patients with treatment success rates that seems at least equally effective as ESWL.

Supplementary material



Publication History

Received: 09 November 2022

Accepted after revision: 30 January 2023

Article published online:
24 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Beyer G, Habtezion A, Werner J. et al. Chronic pancreatitis. Lancet (London, England) 2020; 396: 499-512
    CrossrefPubMedGoogle Scholar
  • 2 Bornman PC, Marks IN, Girdwood AW. et al. Pathogenesis of pain in chronic pancreatitis: ongoing enigma. World J Surg 2003; 27: 1175-1182
    CrossrefPubMedGoogle Scholar
  • 3 Löhr JM, Dominguez-Munoz E, Rosendahl J. et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J 2017; 5: 153-199
    CrossrefPubMedGoogle Scholar
  • 4 Dumonceau J-M, Delhaye M, Tringali A. et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Updated August 2018. Endoscopy 2019; 51: 179-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Choi KS, Kim MH. Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones. J Hepatobiliary Pancreat Surg 2006; 13: 86-93
    CrossrefPubMedGoogle Scholar
  • 6 McCarty TR, Sobani Z, Rustagi T. Per-oral pancreatoscopy with intraductal lithotripsy for difficult pancreatic duct stones: a systematic review and meta-analysis. Endosc Int Open 2020; 08: 1460-1470
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Catalano MF. Endoscopic treatment of pancreatic duct strictures. Tech Gastrointest Endosc 1999; 1: 168-174
    CrossrefPubMedGoogle Scholar
  • 8 van der Wiel SE, Stassen PMC, Poley JW. et al. Pancreatoscopy-guided electrohydraulic lithotripsy for the treatment of obstructive pancreatic duct stones: a prospective consecutive case series. Gastrointest Endosc 2022; 95: 905-914
    CrossrefPubMedGoogle Scholar
  • 9 Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: Introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol 2007; 42: 101-119
    CrossrefPubMedGoogle Scholar
  • 10 Issa Y, Kempeneers MA, Bruno MJ. et al. Effect of early surgery vs endoscopy-first approach on pain in patients with chronic pancreatitis: The ESCAPE randomized clinical trial. JAMA 2020; 323: 237-247
    CrossrefPubMedGoogle Scholar
  • 11 Mols F, Pelle AJ, Kupper N. Normative data of the SF-12 health survey with validation using postmyocardial infarction patients in the Dutch population. Qual Life Res 2009; 18: 403-414
    CrossrefPubMedGoogle Scholar
  • 12 Ware J, Kosinski M, Keller S. How to Score SF-12. Boston: The Health Instiutte, New England Medical Center; 1995
    Google Scholar
  • 13 Cahen DL, Gouma DJ, Laramée P. et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology 2011; 141: 1690-1695
    CrossrefPubMedGoogle Scholar
  • 14 Drewes AM, Krarup AL, Detlefsen S. et al. Pain in chronic pancreatitis: The role of neuropathic pain mechanisms. Gut 2008; 57: 1616-1627
    CrossrefPubMedGoogle Scholar
  • 15 Anderson MA, Akshintala V, Albers KM. et al. Mechanism, assessment and management of pain in chronic pancreatitis: Recommendations of a multidisciplinary study group. Pancreatol Off J Int Assoc Pancreatol 2016; 16: 83-94
    CrossrefPubMedGoogle Scholar
  • 16 Machicado JD, Amann ST, Anderson MA. et al. Quality of life in chronic pancreatitis is determined by constant pain, disability/unemployment, current smoking, and associated co-morbidities. Am J Gastroenterol 2017; 112: 633-642
    CrossrefPubMedGoogle Scholar
  • 17 de Rijk FEM, van Veldhuisen CL, Besselink MG. et al. Implementation of an evidence-based management algorithm for patients with chronic pancreatitis (COMBO trial): study protocol for a stepped-wedge cluster-randomized controlled trial. Trials 2023; 24: 1-10
    PubMedGoogle Scholar
  • 18 Han S, Miley A, Akshintala V. et al. Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial. Pancreatology 2022; 8: 1120-1125
    CrossrefPubMedGoogle Scholar