title: ERCP with per-oral pancreatoscopy-guided laser lithotripsy for calcific chronic pancreatitis: a multicenter U.S. experience.
abstract: BACKGROUND
  In patients with chronic pancreatitis, laser lithotripsy (LL) permits stone fragmentation and removal during ERCP with some advantages over extracorporeal shock-wave lithotripsy (ESWL) and surgery.
  
  
  OBJECTIVE
  To evaluate the technical success of LL in pancreatic duct (PD) stones.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Four tertiary referral centers.
  
  
  METHODS
  Patients undergoing endotherapy for PD stones.
  
  
  METHODS
  ERCP with per-oral pancreatoscopy (POP)-guided LL.
  
  
  METHODS
  Technical success was defined as complete stone clearance.
  
  
  RESULTS
  Over 3 years, 28 patients (16 men, 51 years [mean age]) underwent a median of 1 (range, 1-4) POP-LL for PD stones. Baseline parameters included pain requiring hospitalization (n=19, 68%), opiate use (n=14, 50%), or weight loss (n=11, 39%). Before POP-LL, 22 of 28 patients (79%) had a median of 1 (range, 1-5) ERCP, 9 of 28 (32%) underwent a median of 2 (range, 1-3) ESWL sessions, and 5 underwent a median of 1 (range, 1-3) POP-guided electrohydraulic lithotripsy with failed (n=2) or partial (n=3) fragmentation. A median of 2 (range, 1-3) stones sized 15 mm (range, 4-32 mm) were identified in the head (n=9, 32%), neck (n=3, 11%), body (n=9, 32%), tail (n=1, 4%), or multiple sites (n=6, 21%). Technical success occurred in 22 patients (79%) with complete clearance. Partial clearance occurred in 3 (11%). Clinical success at a median of 13 (range, 1-25) months of follow-up was noted in 25 of 28 patients (89%) by improvement in pain (n=25), decreased narcotic use (n=25), or reduced hospitalizations (n=19). Mild adverse events occurred in 8 of 28 (29%).
  
  
  CONCLUSIONS
  POP-LL is feasible at expert centers in patients with accessible stones. Although intensive endotherapy is required, most patients achieve stone clearance and clinical improvement.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Augustin R
authors.initials: AR
authors.lastname: Attwell
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Texas-San Antonio Medical School, San Antonio, Texas, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Department of Medicine, Weill-Cornell Medical Center, New York, New York, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.affiliation: St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors.forename: Isaac L
authors.initials: IL
authors.lastname: Raijman
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Roy
authors.initials: R
authors.lastname: Yen
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002137:Calculi / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid