Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. ESWL Procedure
2.3. POPS-L Procedure
2.4. Evaluation Criteria
2.5. Definitions
2.6. Statistical Analyses
3. Results
3.1. Characteristics of Patients and Pancreatic Stones
3.2. Treatment Outcomes
3.3. Procedure-Related Complications
3.4. Number of Sessions
3.5. Multivariate Analysis for Treatment Success
3.6. Long-Term Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total n = 66 | POPS-L n = 19 | ESWL n = 47 | p-Value | |
---|---|---|---|---|
Median age, years (range) | 64 (22–86) | 62 (41–86) | 65 (22–80) | 0.744 |
Male, n (%) | 52 (78) | 14 (73.6) | 38 (80.8) | 0.522 |
Etiology of chronic pancreatitis, n (%) | 0.531 | |||
Alcohol-related | 58 (87.8) | 15 (93.7) | 40 (85.1) | |
Idiopathic | 7 (10.6) | 1 (6.0) | 6 (12.7) | |
Autoimmune | 1 (1.5) | 0 | 1 (2.1) | |
Symptom, n (%) | 0.406 | |||
Pain | 21 (31.8) | 4 (21.0) | 17 (36.1) | |
Pancreatitis attack | 32 (48.4) | 9 (47.3) | 23 (48.9) | |
Pseudocyst-related | 2 (3.0) | 1 (5.2) | 1 (2.1) | |
No symptoms (anticipation of preserving pancreatic function) | 11 (16.6) | 5 (26.3) | 6 (12.7) |
Total n = 66 | POPS-L n = 19 | ESWL n = 47 | p-Value | |
---|---|---|---|---|
Median diameter of stone, mm (range) | 10 (5–40) | 10 (5–21) | 10 (5–40) | 0.92 |
Median number of stones, n (%) | 1 (1–3) | 1 (1–3) | 1 (1–3) | 0.186 |
Stone location, n (%) | 1.00 | |||
Head | 51 (77.2) | 15 (78.9) | 36 (76.6) | |
Body/tail | 15 (22.7) | 4 (21.0) | 11 (23.4) | |
Median CT value of stone density, HU (range) | 1043 (43–3814) | 832 (534–1375) | 1069 (43–3814) | 0.126 |
MPD stenosis, n (%) | 28 (42.4) | 11 (57.8) | 17 (36.1) | 0.168 |
Median diameter of downstream MPD of stone, mm (range) | 3.1 (1.4–8) | 3.15 (1.4–8) | 3 (2.1–8) | 0.639 |
Median diameter of upstream MPD of stone, mm (range) | 7.5 (3–15) | 8.5 (5–12.6) | 7 (3–15) | 0.055 |
POPS-L n = 19 | ESWL n = 47 | p-Value | |
---|---|---|---|
Treatment success, n (%) | 15 (78.9) | 33 (70.2) | 0.554 |
Cause of treatment failure, n | |||
Difficulty of POPS insertion near stone | 2 | ||
MPD perforation | 1 | ||
Difficulty due to site (near the Ampula) | 1 | ||
EHL/LL, n | 13/4 | ||
Median number of all sessions, n (range) | 1 (1–4) | 5 (2–28) | p < 0.01 |
Median procedure time, minutes (range) | 72 (30–187) | ||
Median number of ESWL sessions, n (range) | 3 (1–22) | ||
Median number of ESWL shots, n (range) | 9000 (2000–70,000) | ||
ESWL alone/combination of ESWL and endoscopic extraction, n | 17/30 | ||
Complications, n (%) | 4 (21.0) | 3 (6.3) | 0.098 |
Hyperamylasemia | 3 | 0 | |
Pancreatitis | 0 | 1 | |
MPD perforation | 1 | 0 | |
Bleeding | 0 | 2 |
Univariate Analysis | Multivariate Analysis | |||||
---|---|---|---|---|---|---|
Odds Ratio | 95%CI | p-Value | Odds Ratio | 95% CI | p-Value | |
Male | 2.666 | 0.6291–18.419 | 0.196 | 1.814 | 0.366–13.535 | 0.483 |
Age ≥ 65 | 1.607 | 0.541–4.904 | 0.392 | 1.154 | 0.352–3.807 | 0.811 |
Stone diameter ≥ 10 mm | 1.329 | 0.445–4.163 | 0.611 | 1.21 | 0.363–4.129 | 0.755 |
CT value of stone ≥ 1043 HU | 1.87 | 0.624–5.906 | 0.264 | 1.524 | 0.450–5.331 | 0.497 |
Body/tail stone | 1.461 | 0.395–4.969 | 0.554 | |||
Stricture of downstream MPD | 1.12 | 0.367–3.345 | 0.839 | |||
Upstream MPD diameter ≥ 7.5 mm | 0.676 | 0.222–2.008 | 0.481 | |||
Alcohol abuse | 1.142 | 0.234–8.349 | 0.876 | |||
Symptomatic stone | 0.612 | 0.158–2.626 | 0.49 | |||
ESWL | 1.59 | 0.475–6.337 | 0.463 | 1.439 | 0.402–5.958 | 0.582 |
Complications | 1.075 | 0.143–5.562 | 0.935 |
Total n = 48 | POPS-L n = 15 | ESWL n = 33 | p-Value | |
---|---|---|---|---|
Median observation periods, days (range) | 310 (0–4171) | 176 (0–1507) | 329(0–4171) | 0.235 |
Recurrence of pancreatic stone, n (%) | 12 (25.0) | 4 (26.6) | 8 (24.2) | 1 |
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Iwata, K.; Iwashita, T.; Mukai, T.; Iwasa, Y.; Okuno, M.; Yoshida, K.; Maruta, A.; Uemura, S.; Yasuda, I.; Shimizu, M. Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study. Diagnostics 2024, 14, 891. https://doi.org/10.3390/diagnostics14090891
Iwata K, Iwashita T, Mukai T, Iwasa Y, Okuno M, Yoshida K, Maruta A, Uemura S, Yasuda I, Shimizu M. Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study. Diagnostics. 2024; 14(9):891. https://doi.org/10.3390/diagnostics14090891
Chicago/Turabian StyleIwata, Keisuke, Takuji Iwashita, Tsuyoshi Mukai, Yuhei Iwasa, Mitsuru Okuno, Kensaku Yoshida, Akinori Maruta, Shinya Uemura, Ichiro Yasuda, and Masahito Shimizu. 2024. "Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study" Diagnostics 14, no. 9: 891. https://doi.org/10.3390/diagnostics14090891