Long-Term Efficacy and Safety of Digital-Single-Operator-Video-Pancreatoscopy Guided Lithotripsy for Pancreatic Duct Stones.

INTRODUCTION

Ductal decompression has become the main approach for treating patients with symptomatic chronic calcifying pancreatitis and signs of ductal hypertension. Digital single operator video pancreatoscopy (dSOVP) has shown high success rates when compared with more established techniques such as extracorporeal shock wave lithotripsy. However, there is still limited evidence on long-term clinical success and quality of life.

METHODS

Patients with chronic calcifying pancreatitis who underwent digital single operator video pancreatoscopy guided electrohydraulic lithotripsy (EHL) of pancreatic duct stones with initial technical and clinical success were recruited for this retrospective, multicenter cohort study. Persistence of clinical success (defined as pain reduction > 50% in numerical rating scale [NRS]) as well as postinterventional quality of life (QOL) were retrospectively evaluated by database analysis and with QOL using the Mental and Physical Condition Scores (MCS, PCS).

RESULTS

A total of 58 patients were included in the long-term follow-up conducted over 24 months. Significant and sustained pain relief was reported in 70.7% of patients (n = 41) at month 3; this effect persisted until month 24. MCS decreased from 50.36 ± 13.3 at baseline to 49.75 ± 11.1 at month 12 with no statistically significant difference (data available for 42 patients, p = 0.15). Similarly, the PCS showed no significant improvement, remaining constant at 44.9 ± 9.8 at baseline and 44.9 ± 10.8 at month 12 (p = 0.1). The overall adverse event rate was 26% (11 patients), primarily consisting of mild to moderate pancreatitis (n = 9, 22%).

CONCLUSIONS

Digital single operator video pancreatoscopy guided lithotripsy was shown to be safe and effective in a long-term follow-up regarding pain control but had no significant influence on QOL. Complete stone removal seems to be the key point for long-term clinical success.