Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

doi:10.3748/wjg.v26.i34.5207

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World Journal of Gastroenterology

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Meta-Analysis

World J Gastroenterol. Sep 14, 2020; 26(34): 5207-5219
Published online Sep 14, 2020. doi: 10.3748/wjg.v26.i34.5207

Efficacy of pancreatoscopy for pancreatic duct stones: A systematic review and meta-analysis

Syed M Saghir, Harmeet S Mashiana, Babu P Mohan, Banreet S Dhindsa, Amaninder Dhaliwal, Saurabh Chandan, Neil Bhogal, Ishfaq Bhat, Shailender Singh, Douglas G Adler

Syed M Saghir, Banreet S Dhindsa, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, United States

Harmeet S Mashiana, Amaninder Dhaliwal, Saurabh Chandan, Neil Bhogal, Ishfaq Bhat, Shailender Singh, Division of Gastroenterology and Hepatology, University of Nebraska School of Medicine, Omaha, NE 68198-2000, United States

Babu P Mohan, Douglas G Adler, Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, United States

Author contributions: Saghir SM, Mashiana HS and Mohan BP contributed to analysis and interpretation of data; Saghir SM and Mashiana HS contributed to drafting the article; Mashiana HS, Dhindsa BS, Dhaliwal A and Bhogal N contributed to acquisition of data; Chandan S, Bhat I and Adler DG contributed to critical revision; Mashiana HS, Singh S and Adler DG contributed to final approval.

Conflict-of-interest statement: The authors deny any conflict of interest.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Douglas G Adler, FACG, FASGE, MD, Professor, Division of Gastroenterology and Hepatology, University of Utah Health, 50 N Medical Dr., Salt Lake City, UT 84132, United States. douglas.adler@hsc.utah.edu

Received: May 28, 2020
Peer-review started: May 28, 2020
First decision: June 12, 2020
Revised: June 29, 2020
Accepted: August 21, 2020
Article in press: August 21, 2020
Published online: September 14, 2020
Processing time: 103 Days and 14.5 Hours

ARTICLE HIGHLIGHTS

Research background

Painful chronic calcifying pancreatitis management involves pancreatic enzyme replacement therapy, extracorporeal shock wave lithotripsy (ESWL) with or without endoscopic retrograde cholangiopancreatography (ERCP), ERCP with pancreatic sphincterotomy and either balloon or basket retrieval with stent placement, peroral pancreatoscopy (POP) and/or surgery. POP utilizes two different methods for pancreatic stone lithotripsy, which are electrohydraulic lithotripsy (EHL) or laser lithotripsy (LL).

Research motivation

There are limited data regarding the safety and efficacy of POP for symptomatic pancreatic calculi.

Research objectives

We aimed to assess the safety and efficacy of both POP techniques in regard to stone fragmentation. Primary outcomes assessed involved technical and clinical success of POP. Secondary outcomes included technical and clinical success for EHL and LL, and adverse events (AE) for POP, EHL and LL.

Research methods

We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, Cochrane, Google Scholar and Web of Science databases. Statistical analysis was conducted via comprehensive meta-analysis software.

Research results

POP-guided lithotripsy was successful in patients who had failed in the first-line therapy. On indirect comparative analysis, LL was found to have higher technical and clinical success than EHL. POP AE was comparable to ESWL. The AE for EHL and LL was similar on indirect comparison. PEP was the most common AE and was comparable to ESWL.

Research conclusions

POP-guided lithotripsy is a viable option for management of patients with chronic pancreatitis and symptomatic PD stones. We found LL technique to have a higher technical and clinical success rate with comparable AE rates.

Research perspectives

Further randomized controlled trials are needed for head to head comparison of the two techniques and evaluate if POP can be a potential first line therapy in these cases.