ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis: a multicenter US experience

作者：Attwell Augustin R; Patel Sandeep; Kahaleh Michel; Raijman Isaac L; Yen Roy; Shah Raj J^*

来源：Gastrointestinal Endoscopy, 2015, 82(2): 311-318.

DOI：10.1016/j.gie.2015.01.020

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 Z 2) or partial (n Z 3) fragmentation. A median of 2 (range, 1-3) stones sized 15 mm (range, 4-32 mm) were identified in the head (n Z 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, 125) months of follow-up was noted in 25 of 28 patients (89%) by improvement in pain (n = 25), decreased narcotic use (n Z 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.

• 出版日期2015-8