SINGLE-OPERATOR PERORAL CHOLANGIOPANCREATOSCOPY-GUIDED LITHOTRIPSY FOR DIFFICULT BILIARY AND PANCREATIC STONES – A PROSPECTIVE MULTICENTER STUDY

Aims:

ERCP is the first choice for the removal of biliary and pancreatic stones. In difficult stones, advanced therapeutic techniques, such as electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have been proposed. Recently, the availability of single-operator cholangiopancreatoscopy (SOCP) turned these techniques more accessible and easier to perform. We sought to evaluate the clinical efficacy and safety of SOCP guided-lithotripsy using EHL/LL in patients with complex biliary and pancreatic stones.

Methods:

A prospective study was carried out in 3 hospitals, comprising 30 consecutive patients with complicated biliary and pancreatic stones treated with SpyGlass DS (Boston Scientific, Marlborough, United States) guided-lithotripsy using EHL or Holmium LL. We analyzed the complete cleaning of the ducts, the incidence of adverse events, the impact of the number of stones and its location on clinical success, and the performance of the 2 lithotripsy modalities.

Results:

22 patients (73.3%) had common bile duct/common hepatic duct stones, 2 patients (6.7%) had a single cystic stump stone, 4 patients (13.3%) had pancreatic calculi and 2 patients (6.7%) had intrahepatic stones. 28 patients (93.3%) were successfully treated in one procedure and the remaining 2 patients (6.7%) required additional sessions to obtain cleaning of the ducts. 22 patients were treated with LL and 8 patients with EHL; 2 of the EHL-treated patients required more than one probe in the first ERCP; one of these patients was submitted to a subsequent ERCP in which LL was opted in, with success. The median duration of each session was 62 minutes (30 – 110). Complications were mild in 6 patients (20%) and included fever (n = 4), pain (n = 1) and mild pancreatitis (n = 1).

Conclusions:

SOCP guided-lithotripsy using EHL or LL in patients with difficult biliary and pancreatic stones is very effective and is associated with transient and mild complications. There is a clear need for comparative studies between EHL and LL.