Cholangiopancreatoscopy-guided laser dissection and ablation for pancreas and biliary strictures and neoplasia

Abstract

Background and study aims Cholangiopancreatoscopy-guided laser dissection or ablation (CPL) is a novel therapeutic modality for refractory benign strictures. Our aim was to describe the safety and efficacy of CPL for pancreaticobiliary disorders.

Patients and methods Patients who underwent CPL using holmium or thulium laser between February 2017 and September 2019 were included. For stricture dissection, gentle strokes of the laser fiber from a distal to proximal approach were applied until luminal patency permitted advancement of the cholangiopancreatoscope. Immediate technical success was defined as ability to traverse the stricture with the cholangiopancreatoscope after CPL. Short-term technical success was defined as > 90 % resolution of the stricture on follow-up pancreatogram.

Results Eleven patients underwent a mean of 3.6 ERCPs (mean total diameter of 14.2 Fr of stenting) prior to CPL. Indications included pancreatic duct stricture (n = 8), pancreaticojejunostomy anastomotic stricture (n = 1), bile duct stricture (n = 1) and pancreatic intraductal papillary mucinous neoplasm ablation (n = 1). Immediate technical success was 94.1 % and short-term technical success rates was 88.2 %. At a mean follow-up of 12.1 months, there have been no stricture recurrences.

Conclusions CPL may be an effective therapy for strictures refractory to conventional dilation and multiple stenting.

Publikationsverlauf

Eingereicht: 28. Februar 2020

Angenommen: 08. Mai 2020

Artikel online veröffentlicht:
21. Juli 2020

• References

• 1 Talukdar R, Reddy DN. Pancreatic endotherapy for chronic pancreatitis. Gastrointest Endosc Clin North Am 2015; 25: 765-777
• 2 Dumonceau JM, 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
• 3 Tringali A, Bove V, Vadala di Prampero SF. et al. Long-term follow-up after multiple plastic stenting for refractory pancreatic duct strictures in chronic pancreatitis. Endoscopy 2019; 51: 930-935
• 4 Majumder S, Chari ST. Chronic pancreatitis. Lancet 2016; 387: 1957-1966
• 5 Mittal C, Shah RJ. Pancreatoscopy-guided laser dissection and ablation for treatment of benign and neoplastic pancreatic disorders: an initial report (with videos). Gastrointest Endosc 2018;
• 6 Han S, Shah RJ. Laser dissection for recalcitrant pancreaticojejunostomy anastomotic stricture. VideoGIE 2019; 4: 428-430
• 7 Patel S, Kiker D, Linsteadt J. et al. Holmium:YAG laser safety data on bile duct epithelium in the porcine model. Gastrointest Endosc 2009; 69: AB258
• 8 Lou J, Hu Q, Ma T. et al. A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary stricture. BMC Gastroenterol 2019; 19: 172
• 9 Attwell AR, Patel S, Kahaleh M. et al. ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience. Gastrointest Endosc 2015; 82: 311-318
• 10 Tontini GE, Neumann H, Pastorelli L. et al. Thulium laser in interventional endoscopy: animal and human studies. Endoscopy 2017; 49: 365-370
• 11 Chandrasekhara V, Khashab MA, Muthusamy VR. et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
• 12 Tringali A, Vadala di Prampero SF. et al. Fully covered self-expandable metal stents to dilate persistent pancreatic strictures in chronic pancreatitis: long-term follow-up from a prospective study. Gastrointest Endosc 2018; 88: 939-946
• 13 Sharaiha RZ, Novikov A, Weaver K. et al. Fully covered self-expanding metal stents for refractory pancreatic duct strictures in symptomatic chronic pancreatitis, US experience. Endosc Int Open 2019; 7: E1419-e1423
• 14 Brown NG, Camilo J, McCarter M. et al. Refractory Jaundice from intraductal papillary mucinous neoplasm treated with cholangioscopy-guided radiofrequency ablation. ACG Case Rep Journal 2016; 3: 202-204
• 15 Choi JH, Lee SH, Choi YH. et al. Safety of endoscopic ultrasound-guided ethanol ablation for pancreatic cystic lesions: A single-center experience of 214 patients. Hepatobil Pancr Dis Int 2019; 18: 562-568
• 16 Baughman SM, Bishoff JT, Zimmerman MK. et al. Case report: serial percutaneous cholangioscopy with laser ablation for the management of locally recurrent biliary intraductal papillary mucinous tumor. J Gastrointest Surgery 2005; 9: 215-218