Bekkali Noor L H, Murray Sam, Johnson Gavin J, Bandula Steven, Amin Zahir, Chapman Michael H, Pereira Stephen P, Webster George J M
From the *Pancreatobiliary Medicine Unit and †Radiology Department, University College London Hospitals, London, United Kingdom.
Pancreas. 2017 Apr;46(4):528-530. doi: 10.1097/MPA.0000000000000790.
Painful chronic pancreatitis is often associated with main duct obstruction due to stones. Approaches to management are challenging, including surgery, extracorporeal shock wave lithotripsy, or endoscopic approaches. Here, we report our experience of pancreatoscopy + electrohydraulic lithotripsy (EHL) for pancreatic duct (PD) stones using SpyGlass.
We retrospectively audited the use of SpyGlass (Legacy and DS) + EHL. Indication, procedural details, and clinical outcomes were assessed.
A total of 118 SpyGlass + EHL procedures for stones were performed, of which 8 (7%) for pancreatic stones, in 6 patients (3 female; mean [standard deviation] age, 45 [7] years). All patients had painful chronic pancreatitis, with radiological evidence of a dilated PD, and main duct stone disease. Surgical options had been considered in all cases. Stone fragmentation and PD decompression were achieved in 83% (n = 5) without complications. Two patients required 2 EHL procedures to achieve clearance. In 1 patient with failed clearance, pancreatoscopy revealed a stone in the adjacent parenchyma and not in PD. All patients with successful EHL had pain relief/marked improvement at clinical review (mean [standard deviation] follow-up, 2.7 [1.1] years).
Pancreatoscopy + EHL may have a valuable role in treating obstructing PD stones, possibly avoiding the need for surgery in some patients.
疼痛性慢性胰腺炎常与结石导致的主胰管梗阻相关。其治疗方法具有挑战性，包括手术、体外冲击波碎石术或内镜治疗方法。在此，我们报告使用SpyGlass进行胰管镜检查 + 电液压碎石术（EHL）治疗胰管（PD）结石的经验。
我们回顾性分析了SpyGlass（传统型和DS型）+ EHL的使用情况。评估了适应证、操作细节和临床结果。
共进行了118例SpyGlass + EHL结石治疗手术，其中8例（7%）用于治疗胰腺结石，涉及6例患者（3例女性；平均[标准差]年龄为45[7]岁）。所有患者均患有疼痛性慢性胰腺炎，影像学显示主胰管扩张且存在主胰管结石病。所有病例均考虑过手术治疗方案。83%（n = 5）的患者实现了结石破碎和主胰管减压，且无并发症。2例患者需要进行2次EHL手术才能清除结石。1例清除失败的患者，胰管镜检查发现结石位于邻近实质而非主胰管内。所有EHL治疗成功的患者在临床复查时疼痛缓解/明显改善（平均[标准差]随访时间为2.7[1.1]年）。
胰管镜检查 + EHL在治疗梗阻性主胰管结石方面可能具有重要作用，可能使部分患者无需接受手术治疗。
