Advertisement

Tips for Using SpyGlass Peroral Pancreatoscopy and X-Ray-Guided Electrohydraulic Lithotripsy for Refractory Pancreatic Stones

  • Ken Ito
  • Yoshinori Igrashi
  • Naoki Okano
  • Kensuke Yoshimoto
  • Susumu Iwasaki
  • Seiichi Hara
  • Kensuke Takuma
  • Yui Kishimoto
Chapter

Abstract

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.

Keywords

Electrohydraulic lithotripsy Pancreatic stones Peroral pancreatoscopy 

Notes

Acknowledgments

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.

References

  1. 1.
    Ohara H, Hoshino M, Hayakawa T, et al. Single application extracorporeal shock wave lithotripsy is the first choice for patients with pancreatic duct stones. Am J Gastroenterol. 1996;91:1388–94.PubMedGoogle Scholar
  2. 2.
    Sauerbruch T, Holl J, Sackmann M, et al. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis. Endoscopy. 1987;19:207–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Howell DA, Dy RM, Hanson BL, et al. Endoscopic treatment of pancreatic duct stones using a 10F pancreatoscope and electrohydraulic lithotripsy. Gastrointest Endosc. 1999;50:829–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Inui K, Tazuma S, Yamaguchi T, et al. Treatment of pancreatic stones with extracorporeal shock wave lithotripsy: results of a multicenter survey. Pancreas. 2005;30:26–30.PubMedGoogle Scholar
  5. 5.
    Dumonceau JM, Costamagna G, Tringali A, et al. Treatment for painful calcified chronic pancreatitis: extracorporeal shock wave lithotripsy versus endoscopic treatment: a randomised controlled trial. Gut. 2007;56:545–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Morrow CE, Cohen JI, Sutherland DE, et al. Chronic pancreatitis: long-term surgical results of pancreatic duct drainage, pancreatic resection, and near-total pancreatectomy and islet autotransplantation. Surgery. 1984;96:608–16.PubMedGoogle Scholar
  7. 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
  8. 8.
    Dumonceau JM, Delhaye M, Tringali A, et al. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2012;44:784–800.CrossRefPubMedGoogle Scholar
  9. 9.
    Platonov MA, Gillis AM, Kavanagh KM, et al. Pacemakers, implantable cardioverter/defibrillators, and extracorporeal shockwave lithotripsy: evidence-based guidelines for the modern era. J Endourol. 2008;22:243–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol. 2010;24:281–98.CrossRefPubMedGoogle Scholar
  11. 11.
    Tandan M, Reddy DN, Santosh D, et al. Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi-a large single center experience. Indian J Gastroenterol. 2010;29:143–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Joo YW, Yoon JH, Cho SC, et al. Endoscopic pancreatic sphincterotomy: indications and complications. Korean J Intern Med. 2009;24:190–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hirai T, Goto H, Hirooka Y, et al. Pilot study of pancreatoscopic lithotripsy using a 5-fr instrument: selected patients may benefit. Endoscopy. 2004;36:212–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Rios GA, Adams DB. Does intraoperative electrohydraulic lithotripsy improve outcome in the surgical management of chronic pancreatitis? Am Surg. 2001;67:533–7; discussion 537–8PubMedGoogle Scholar
  15. 15.
    Attwell AR, Brauer BC, Chen YK, et al. Endoscopic retrograde cholangiopancreatography with per oral pancreatoscopy for calcific chronic pancreatitis using endoscope and catheter-based pancreatoscopes: a 10-year single-center experience. Pancreas. 2014;43:268–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Sherman S, Lehman GA, Hawes RH, et al. Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms. Gastrointest Endosc. 1991;37:511–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Delhaye M, Matos C, Deviere J. Endoscopic technique for the management of pancreatitis and its complications. Best Pract Res Clin Gastroenterol. 2004;18:155–81.CrossRefPubMedGoogle Scholar
  18. 18.
    Shah RJ, Langer DA, Antillon MR, et al. Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology. Clin Gastroenterol Hepatol. 2006;4:219–25.CrossRefPubMedGoogle Scholar
  19. 19.
    Itoi T, Moon JH, Waxman I, et al. Current status of direct peroral cholangioscopy. Dig Endosc. 2011;23(Suppl 1):154–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Nguyen NQ, Shah JN, Binmoeller KF, et al. Diagnostic cholangioscopy with SpyGlass probe through an endoscopic retrograde cholangiopancreatography cannula. Endoscopy. 2010;42(Suppl 2):E288–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Chen YK, Pleskow DK. SpyGlass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc. 2007;65:832–41.CrossRefPubMedGoogle Scholar
  22. 22.
    Moon JH, Cha SW, Ryu CB, et al. Endoscopic treatment of retained bile-duct stones by using a balloon catheter for electrohydraulic lithotripsy without cholangioscopy. Gastrointest Endosc. 2004;60:562–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Papachristou GI, Baron TH. Endoscopic treatment of an impacted pancreatic duct stone using a balloon catheter for electrohydraulic lithotripsy without pancreatoscopy. J Clin Gastroenterol. 2006;40:753–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Ken Ito
    • 1
  • Yoshinori Igrashi
    • 1
  • Naoki Okano
    • 1
  • Kensuke Yoshimoto
    • 1
  • Susumu Iwasaki
    • 1
  • Seiichi Hara
    • 1
  • Kensuke Takuma
    • 1
  • Yui Kishimoto
    • 1
  1. 1.Division of Gasroenterology and HepatologyToho University, Omori Medical CenterTokyoJapan

Personalised recommendations