McCarty Thomas R, Sobani Zain, Rustagi Tarun
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.
Division of Gastroenterology and Hepatology, University of New Mexico, Albuquerque, New Mexico, United States.
Endosc Int Open. 2020 Oct;8(10):E1460-E1470. doi: 10.1055/a-1236-3187. Epub 2020 Oct 7.
Per-oral pancreatoscopy (POP) with intraductal lithotripsy via electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL) facilitates optically-guided stone fragmentation of difficult pancreatic stones refractory to conventional endoscopic therapy. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of POP with intraductal lithotripsy for difficult pancreatic duct stones. Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. This was a cumulative meta-analysis performed by calculating pooled proportions with rates estimated using random effects models. Measured outcomes included pooled technical success, complete or partial stone fragmentation success, complete duct clearance after initial lithotripsy session, and adverse events (AEs). Ten studies (n = 302 patients; 67.72 % male; mean age 55.10 ± 3.22 years) were included with mean stone size of 10.66 ± 2.19 mm. The most common stone location was in the pancreatic head (66.17 %). Pooled technical success was 91.18 % with an overall fragmentation success of 85.77 %. Single lithotripsy session stone fragmentation and pancreatic duct clearance occurred in 62.05 % of cases. Overall, adverse events were reported in 14.09 % of patients with post-procedure pancreatitis developing in 8.73 %. Of these adverse events, 4.84 % were classified as serious. Comparing POP-EHL vs POP-LL, there was no significant difference in technical success, fragmentation success, single session duct clearance, or AEs ( > 0.0500). Based on this systematic review and meta-analysis, POP with intraductal lithotripsy appears to be an effective and relatively safe procedure for patients with difficult to remove pancreatic duct stones.
经口胰管镜检查（POP）联合通过电液压碎石术（EHL）或激光碎石术（LL）进行的导管内碎石术，有助于对传统内镜治疗难治的困难胰腺结石进行光学引导下的结石破碎。本研究的目的是进行系统评价和荟萃分析，以评估POP联合导管内碎石术治疗困难胰管结石的疗效和安全性。根据系统评价和荟萃分析的首选报告项目以及流行病学观察性研究荟萃分析指南制定了个性化的检索策略。这是一项累积荟萃分析，通过使用随机效应模型估计的率来计算合并比例。测量的结果包括合并技术成功率、结石完全或部分破碎成功率、初次碎石术后导管完全清除率以及不良事件（AE）。纳入了10项研究（n = 302例患者；男性占67.72%；平均年龄55.10±3.22岁），平均结石大小为10.66±2.19 mm。最常见的结石位置在胰头（66.17%）。合并技术成功率为91.18%，总体破碎成功率为85.77%。62.05%的病例在单次碎石术中实现了结石破碎和胰管清除。总体而言，14.09%的患者报告了不良事件，其中8.73%发生了术后胰腺炎。在这些不良事件中，4.84%被归类为严重不良事件。比较POP-EHL与POP-LL，在技术成功率、破碎成功率、单次手术导管清除率或不良事件方面无显著差异（P>0.0500）。基于这项系统评价和荟萃分析，POP联合导管内碎石术对于难以清除的胰管结石患者似乎是一种有效且相对安全的手术。
