Limits...
Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis.

Ito K, Igarashi Y, Okano N, Mimura T, Kishimoto Y, Hara S, Takuma K - Biomed Res Int (2014)

Bottom Line: Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases.Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003).In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.

ABSTRACT

Introduction: To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis.

Methods: For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options.

Results: Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003).

Conclusions: In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

Show MeSH

Related in: MedlinePlus

Dilators for MPD stricture.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4066860&req=5

fig2: Dilators for MPD stricture.

Mentions: All procedures were performed with a TJF240 or TJF260V duodenoscope (Olympus Medical Systems, Tokyo, Japan). EPST was always performed as the first step, and when selective intubation was difficult, precutting was performed with EPST as a secondary procedure [7]. When pancreatic duct stricture was recognized on pancreatography, a guidewire was negotiated through the tail of the pancreatic duct as close as possible to the tail of the MPD, and dilatation was attempted. Although we typically used 0.035-inch Revowave standard type and Revowave hard-type guidewires (Piolax Medical Devices, Inc. Kanagawa, Japan), we used a 0.025-inch Visi-Glide guidewire (Olympus Medical Systems) when stricture was severe because traversing the stricture effectively with a standard guidewire is difficult. When the guidewire was negotiated through the tail of the MPD, a dilatation device such as a Soehendra biliary dilatation catheter (SBDC; Wilson Cook Medical, Winston-Salem, NC), Soehendra stent retriever catheter (SSR; Wilson Cook Medical), or Maxpass (Olympus Medical Systems) was used (Figure 2). In cases of radiopaque stones, an endoscopic nasopancreatic drain (ENPD) was placed, and contrast media was infused through the ENPD during ESWL to identify stones. To improve the efficacy of lithotripsy, a slow shock wave (45 pulses/min) was applied using an electromagnetic Siemens Lithoskop (Siemens AG, Munich, Germany).


Efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy, and additional electrohydraulic lithotripsy using the SpyGlass direct visualization system or X-ray guided EHL as needed, for pancreatic lithiasis.

Ito K, Igarashi Y, Okano N, Mimura T, Kishimoto Y, Hara S, Takuma K - Biomed Res Int (2014)

Dilators for MPD stricture.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4066860&req=5

fig2: Dilators for MPD stricture.
Mentions: All procedures were performed with a TJF240 or TJF260V duodenoscope (Olympus Medical Systems, Tokyo, Japan). EPST was always performed as the first step, and when selective intubation was difficult, precutting was performed with EPST as a secondary procedure [7]. When pancreatic duct stricture was recognized on pancreatography, a guidewire was negotiated through the tail of the pancreatic duct as close as possible to the tail of the MPD, and dilatation was attempted. Although we typically used 0.035-inch Revowave standard type and Revowave hard-type guidewires (Piolax Medical Devices, Inc. Kanagawa, Japan), we used a 0.025-inch Visi-Glide guidewire (Olympus Medical Systems) when stricture was severe because traversing the stricture effectively with a standard guidewire is difficult. When the guidewire was negotiated through the tail of the MPD, a dilatation device such as a Soehendra biliary dilatation catheter (SBDC; Wilson Cook Medical, Winston-Salem, NC), Soehendra stent retriever catheter (SSR; Wilson Cook Medical), or Maxpass (Olympus Medical Systems) was used (Figure 2). In cases of radiopaque stones, an endoscopic nasopancreatic drain (ENPD) was placed, and contrast media was infused through the ENPD during ESWL to identify stones. To improve the efficacy of lithotripsy, a slow shock wave (45 pulses/min) was applied using an electromagnetic Siemens Lithoskop (Siemens AG, Munich, Germany).

Bottom Line: Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases.Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003).In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology and Hepatology, Toho University, Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.

ABSTRACT

Introduction: To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis.

Methods: For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options.

Results: Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P = 0.0003).

Conclusions: In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.

Show MeSH
Related in: MedlinePlus