Endoscopy 2018; 50(04): S81-S82
DOI: 10.1055/s-0038-1637269
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 4: Advanced procedures (cholangioscopy, pancreas)
Georg Thieme Verlag KG Stuttgart · New York

DIGITAL SINGLE-OPERATOR VIDEO PANCREATOSCOPY (SPYGLASSDS) WITH LITHOTRIPSY IN CHRONIC CALCIFYING PANCREATITIS WITH OBSTRUCTING STONE OF THE MAIN PANCREATIC DUCT: RETROSPECTIVE SERIES OF 23 CASES

G Christian
1   Evangelisches Krankenhaus Düsseldorf, Department of Gastroenterology, Düsseldorf, Germany
,
D Pullmann
1   Evangelisches Krankenhaus Düsseldorf, Department of Gastroenterology, Düsseldorf, Germany
,
P Siersema
2   Radboud University Nijmegen, Department of Endoscopic Gastrointestinal Oncology, Nijmegen, Netherlands
,
E van Geenen
2   Radboud University Nijmegen, Department of Endoscopic Gastrointestinal Oncology, Nijmegen, Netherlands
,
H Neuhaus
1   Evangelisches Krankenhaus Düsseldorf, Department of Gastroenterology, Düsseldorf, Germany
,
T Beyna
1   Evangelisches Krankenhaus Düsseldorf, Department of Gastroenterology, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

The role of per oral pancreatoscopy (POP) in pancreatic duct (PD) stone treatment is still not clear and ESWL is still the gold standard in non-surgical treatment. Since 2015 single-operator video cholangio-/pancreatoscopy system is available. Our aim was to present the so far largest series of dedicated POP guided PD-Stone lithotripsy using SpyGlassDS.

Methods:

Retrospective analysis of POP guided lithotripsy (holmium laser, EHL) in chronic calcifying pancreatitis patients with (sub-)total main-PD duct occlusion by stones. Primary outcome was technical success and clinical outcome in terms of pain reduction and quality of life after 3 – 6 months. Secondary outcome was adverse event rate. Technical success was defined as PD decompression through complete duct clearance or significant duct clearance making a stent placement possible.

Results:

23 interventions in 20 patients were performed within 2 years. Prior interventional procedures despite POP were performed in 95% of the cases. Technical success was reported in all patients. Mild pancreatitis occurred in 44%. All cases could be successfully treated conservatively. One PD leakage (clinically asymptomatic) and one limited post sphincterotomy bleeding occurred. Both were managed endoscopically. 95% reported a noticeable improvement of symptoms and reduction of painkiller. One patient was lost to follow up. Pain levels could be decreased from 5.37 [± 1.63] to 2.79[± 1.832] in numerical rating scale (P < 0.01). 89% reported no or only mild disablement in daily life, 47% described their general health status as “excellent” or “very good”.

Conclusions:

SpyGlassDS guided lithotripsy of PD stones is safe and technically successful even in patients with prior unsuccessful interventional therapy. Complete or partial stone removal by SpyGlassDS guided lithotripsy had a significant beneficial effect on pain reduction and quality of life.