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

Florence E M de Rijk; Pauline M C Stassen; Sophia E van der Wiel; Marja A Boermeester; Yama Issa; Marinus A Kempeneers; Robert C Verdonk; Marco J Bruno; Pieter Jan F de Jonge

doi:10.1055/a-2035-8969

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

Endosc Int Open. 2023 Mar 24;11(3):E296-E304. doi: 10.1055/a-2035-8969. eCollection 2023 Mar.

Authors

Florence E M de Rijk^{1

2}, Pauline M C Stassen^{1

2}, Sophia E van der Wiel¹, Marja A Boermeester^{3

4}, Yama Issa^{3

4}, Marinus A Kempeneers^{3

4}, Robert C Verdonk⁵, Marco J Bruno¹, Pieter Jan F de Jonge¹

Affiliations

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.
³ Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, The Netherlands.
⁴ Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands.
⁵ Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.

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.

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