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Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? Systematic review
Author(s) -
Beyna Torsten,
Neuhaus Horst,
Gerges Christian
Publication year - 2018
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12909
Subject(s) - medicine , extracorporeal shock wave lithotripsy , lithotripsy , adverse effect , gold standard (test) , randomized controlled trial , pancreatitis , pancreatic duct , general surgery , surgery
Background and Aim The main treatment aim in chronic pancreatitis ( CP ) is symptom control and especially pain relief. Management of stone‐predominant CP is challenging and requires a multidisciplinary approach. Extracorporeal shock wave lithotripsy ( ESWL ) has emerged as the cornerstone of non‐surgical treatment as a result of disappointing results of available endoscopic treatment options during the last decades. With new developments in the field of direct peroral pancreatoscopy ( POP ) and intracorporeal lithotripsy, direct intraluminal treatment of main pancreatic duct ( MPD ) stones returns to the spotlight. Methods Herein, we reviewed the current data on direct pancreatoscopic treatment of MPD stones with a focus on efficiency and safety of available technologies, endoscopes and lithotripsy devices. A systematic Medline search for relevant studies was done. Results Ten relevant publications meeting the inclusion criteria were identified (two prospective series, six retrospective trials, two case reports, n = 87 patients). Successful ductal clearance for POP ‐guided treatment was reported as between 43% and 100% compared to ESWL with 59% to 80%. Adverse event rate for POP ‐guided therapy was reported as 0–13.5%. One study showed a noticeable higher adverse event rate of 43%. In this trial, POP was carried out after ESWL . There is no reported mortality following POP treatment. Conclusion Available results are promising in terms of ductal clearance and pain relief compared to standard endoscopic techniques and ESWL as the current gold standard for lithotripsy. Interpretation of this data is limited by the small number of cases for POP and the lack of prospective randomized controlled trials.