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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.

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Related in: MedlinePlus

X-ray guided EHL.
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fig4: X-ray guided EHL.

Mentions: If the endoscopic lithotomy/ESWL combination was unsuccessful, EHL was performed as a second attempt. Before 2010, we used a 3.5 mm diameter CHF TYPE BP 260 baby scope (Olympus Medical Systems) for EHL. However, because of its naïve characteristics and fragility, we switched to the 10 Fr SpyGlass Direct Visualization system (Boston Scientific, Natick, MA) for EHL. The NORTECH MICRO II 1.9 Fr 250 cm EHL Probe (Northgate Technologies Inc., Elgin, IL) and NORTECH AUTOLITH EHL Generator (Northgate Technologies Inc.) were optimized for use with the SpyGlass Direct Visualization system (Figure 3). Alternatively, X-ray guided EHL using a 7 Fr biliary dilator as an outer sheath was performed when a 10 Fr SpyGlass system delivery catheter was difficult to insert into the MPD stricture (Figure 4).


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)

X-ray guided EHL.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: X-ray guided EHL.
Mentions: If the endoscopic lithotomy/ESWL combination was unsuccessful, EHL was performed as a second attempt. Before 2010, we used a 3.5 mm diameter CHF TYPE BP 260 baby scope (Olympus Medical Systems) for EHL. However, because of its naïve characteristics and fragility, we switched to the 10 Fr SpyGlass Direct Visualization system (Boston Scientific, Natick, MA) for EHL. The NORTECH MICRO II 1.9 Fr 250 cm EHL Probe (Northgate Technologies Inc., Elgin, IL) and NORTECH AUTOLITH EHL Generator (Northgate Technologies Inc.) were optimized for use with the SpyGlass Direct Visualization system (Figure 3). Alternatively, X-ray guided EHL using a 7 Fr biliary dilator as an outer sheath was performed when a 10 Fr SpyGlass system delivery catheter was difficult to insert into the MPD stricture (Figure 4).

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