Endoscopy 2004; 36(3): 212-216
DOI: 10.1055/s-2004-814250
Original Article
© Georg Thieme Verlag Stuttgart · New York

Pilot Study of Pancreatoscopic Lithotripsy Using a 5-Fr Instrument: Selected Patients May Benefit

T.  Hirai1 , H.  Goto1, 2 , Y.  Hirooka1, 2 , A.  Itoh1 , S.  Hashimoto1 , Y.  Niwa1 , T.  Hayakawa1, 2
  • 1 Second Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan
  • 2 Department of Endoscopy, Nagoya University School of Medicine, Nagoya, Japan
Weitere Informationen

Publikationsverlauf

Submitted 10 December 2002

Accepted after Revision 5 August 2003

Publikationsdatum:
26. Februar 2004 (online)

Background and Study Aims: Despite advances in endoscopic procedures and extracorporeal shock wave lithotripsy (ESWL), the removal of impacted pancreatic duct stones demands a certain amount of time. The aim of this study was to determine which patient group might suitable for our single-session treatment.
Patients and Methods: The study included 17 patients who were symptomatic due to relapsing pancreatitis with pancreatic duct stones. A 5-Fr miniscope was inserted via the papilla to the impacted pancreatic duct stone and pancreatoscopic laser lithotripsy (PSLL) was performed, under direct vision, in only one session. If complete extraction of the pancreatic duct stones was not achieved with PSLL, ESWL was adopted in subsequent sessions.
Results: Complete extraction of the pancreatic duct stones using PSLL in a single session was achieved in eight of 17 patients. Single-session PSLL was only suitable for patients with pancreatic duct stones smaller than 17 mm in diameter and with no severe stricture or sharp bend in the pancreatic duct proximal to the stones.
Conclusions: Our single-session endoscopic treatment of pancreatic duct stones was useful in a selected patient group.

References

  • 1 Huibregtse K, Schneider B, Vrij A A. et al . Endoscopic pancreatic drainage in chronic pancreatitis.  Gastrointest Endosc. 1988;  34 9-15
  • 2 Sherman S, Lehman G A, Hawes R H. et al . Pancreatic ductal stones: frequency of successful endoscopic removal and improvement in symptoms.  Gastrointest Endosc. 1991;  37 511-517
  • 3 Dumonceau J M, Deviere J, Le Moine O. et al . Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results.  Gastrointest Endosc. 1996;  43 547-555
  • 4 Smits M E, Rauws E A, Tytgat G N. et al . Endoscopic treatment of pancreatic stones in patients with chronic pancreatitis.  Gastrointest Endosc. 1996;  43 556-560
  • 5 Freeman M L. Mechanical lithotripsy of pancreatic duct stones.  Gastrointest Endosc. 1996;  44 333-336
  • 6 Delhaye M, Vandermeeren A, Baize M. et al . Extracorporeal shock-wave lithotripsy of pancreatic calculi.  Gastroenterology. 1992;  102 610-620
  • 7 Sauerbruch T, Holl J, Sackmann M. et al . Extracorporeal lithotripsy of pancreatic stones in patients with chronic pancreatitis and pain: a prospective follow up study.  Gut. 1992;  33 969-972
  • 8 Schneider H T, May A, Benninger J. et al . Piezoelectric shock wave lithotripsy of pancreatic duct stones.  Am J Gastroenterol. 1994;  89 2042-2048
  • 9 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 1388-1394
  • 10 Costamagna G, Gabbrielli A, Mutignani M. et al . Extracorporeal shock wave lithotripsy of pancreatic stones in chronic pancreatitis: immediate and medium-term results.  Gastrointest Endosc. 1997;  46 231-236
  • 11 Cremer M, Toussaint J, Hermanus A. et al . Les pancréatites primitives: classification sur base de la pancréatographie endoscopique.  Acta Gastroenterol Belg. 1976;  39 522-546
  • 12 Manfredi R, Brizi M G, Tancioni V. et al . Magnetic resonance pancreatography (MRP): morphology and function.  Rays. 2001;  26 127-133
  • 13 Hellund J C, Geitung J T, Meo A M. et al . Secretin stimulated magnetic resonance cholangiopancreatography in diseases of the biliary and pancreatic ducts.  Tidsskr Nor Laegeforen. 2002;  122 691-694
  • 14 Feldman R K, Freeny P C, Kozarek R A. Pancreatic and biliary calculi: percutaneous treatment with tunable dye laser lithotripsy.  Radiology. 1990;  174 793-795
  • 15 Renner I G. Laser fragmentation of pancreatic stones.  Endoscopy. 1991;  23 166-170
  • 16 Maier M, Jakobs R, Kohler B. et al . Fluoroscopically guided laser lithotripsy of a pancreatic duct stone.  Endoscopy. 1994;  26 247-249
  • 17 Neuhaus H, Hoffmann W, Classen M. Laser lithotripsy of pancreatic and biliary stones via 3.4 mm and 3.7 mm miniscopes: first clinical results.  Endoscopy. 1992;  24 208-214
  • 18 Howell D A, Dy R M, Hanson B L. et al . Endoscopic treatment of pancreatic duct stones using a 10F pancreatoscope and electrohydraulic lithotripsy.  Gastrointest Endosc. 1999;  50 829-833

Y. Hirooka, M. D. 

Second Department of Internal Medicine, Nagoya University School of Medicine ·

65 Tsuruma-cho · Showa-ku · Nagoya 466-8550 · Japan

Fax: +81-52-7442180 ·

eMail: hirooka@med.nagoya-u.ac.jp