经口胰管镜引导下碎石术与体外冲击波碎石术治疗胰腺结石的Meta分析
Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis.
作者信息
Siranart Noppachai, Kozai Landon, Simadibrata Daniel Martin, Pornananrat Nawan, Roongphornchai Peerada, Pajareya Patavee, Worapongpaiboon Rinrada, Phutinart Somkiat, Dendumrongsup Wichapol, Chumpangern Yanisa, Jaroenlapnopparat Aunchalee, Vantanasiri Kornpong, Tantitanawat Kittithat
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Medicine, University of Hawaii, Honolulu, HI, USA.
出版信息
Dig Dis Sci. 2025 Apr 2. doi: 10.1007/s10620-025-08952-w.
INTRODUCTION
Pancreatic duct stones (PDS) pose a significant clinical challenge, and choosing treatment modality is crucial to achieving optimal outcomes. Extracorporeal shock wave lithotripsy (ESWL) has long been regarded as the primary intervention for PDS. However, per-oral pancreatoscopy-guided lithotripsy (POP), both electrohydraulic lithotripsy (EHL-POP) and laser lithotripsy (LL-POP), has emerged as a promising endoscopic alternative. This meta-analysis compares the efficacy and safety profiles of EHL-POP, LL-POP, and ESWL for treating PDS.
METHODS
A search of MEDLINE, EMBASE, and Cochrane databases until November 2023 was conducted to identify studies assessing the use of EHL-POP, LL-POP, or ESWL for the treatment of PDS. Primary outcomes were technical success and clinical success of stones. Secondary outcomes were any adverse events (AEs) and the incidence of post-intervention pancreatitis.
RESULTS
A total of 45 observational studies were included. Among the 9624 patients with PDS analyzed, 373 underwent POP (238 EHL-POP and 135 LL-POP), while 9,251 underwent ESWL. The pooled technical and clinical success rates of ESWL versus POP were 85.5% (95% CI: 79.1-90.2%) vs. 88.1% (95% CI: 75.1-94.8%) (p = 0.66) and 78.5% (95% CI: 70.9-84.5%) vs. 81.6% (95% CI: 65.1-91.4%) (p = 0.69), respectively. The pooled technical success rate of EHL-POP was 85.2% (95% CI: 68.5-93.9%, I = 63%), which was comparable to LL-POP at 92.7% (95% CI: 64.4-98.9%, I = 0%) (p = 0.48). The clinical success rates of EHL-POP and LL-POP were 74.4% (95% CI: 50.7-89.2%, I = 48%) and 85.7% (95% CI: 63.9-95.3%, I = 68%), respectively (p = 0.38). The rates of any adverse events and post-intervention pancreatitis for ESWL vs. POP were 10.1% (95% CI: 5.5-17.6%, I = 95%) vs. 9.3% (95% CI: 4.1-19.6%, I = 55%) (p = 0.87) and 4.3% (95% CI: 3.1-5.9%, I = 85%) vs. 2.8% (95% CI: 1.3-6.1%, I = 0%) (p = 0.32), respectively.
CONCLUSION
Both EHL-POP and LL-POP, emerges as highly effective and safe alternatives for managing PDS, with safety profiles comparable to ESWL. POP could be considered as an alternative first-line option to ESWL for PDS.
引言
胰管结石（PDS）带来了重大的临床挑战，选择治疗方式对于实现最佳治疗效果至关重要。体外冲击波碎石术（ESWL）长期以来一直被视为PDS的主要干预手段。然而，经口胰管镜引导下碎石术（POP），包括电液压碎石术（EHL-POP）和激光碎石术（LL-POP），已成为一种有前景的内镜替代方法。本荟萃分析比较了EHL-POP、LL-POP和ESWL治疗PDS的疗效和安全性。
方法
检索MEDLINE、EMBASE和Cochrane数据库至2023年11月，以识别评估EHL-POP、LL-POP或ESWL用于治疗PDS的研究。主要结局是结石的技术成功率和临床成功率。次要结局是任何不良事件（AE）和干预后胰腺炎的发生率。
结果
共纳入45项观察性研究。在分析的9624例PDS患者中，373例接受了POP（238例EHL-POP和135例LL-POP），而9251例接受了ESWL。ESWL与POP的汇总技术成功率和临床成功率分别为85.5%（95%CI：79.1-90.2%）对88.1%（95%CI：75.1-94.8%）（p = 0.66）和78.5%（95%CI：70.9-84.5%）对81.6%（95%CI：65.1-91.4%）（p = 0.69）。EHL-POP的汇总技术成功率为85.2%（95%CI：68.5-93.9%，I = 63%），与LL-POP的92.7%（95%CI：64.4-98.9%，I = 0%）相当（p = 0.48）。EHL-POP和LL-POP的临床成功率分别为74.4%（95%CI：50.7-89.2%，I = 48%）和85.7%（95%CI：63.9-95.3%，I = 68%）（p = 0.38）。ESWL与POP的任何不良事件和干预后胰腺炎的发生率分别为10.1%（95%CI：5.5-17.6%，I = 95%）对9.3%（95%CI：4.1-19.6%，I = 55%）（p = 0.87）和4.3%（95%CI：3.1-5.9%，I = 85%）对2.8%（95%CI：1.3-6.1%，I = 0%）（p = 0.32）。
结论
EHL-POP和LL-POP均成为治疗PDS的高效且安全的替代方法，其安全性与ESWL相当。对于PDS，POP可被视为ESWL的替代一线选择。
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