Pancreatoscopy in the evaluation and management of pancreatic disorders

Table 1 Practical considerations for pancreatoscopy

Practical considerations
The amount of contrast injected into the pancreatic duct does not interfere with the pancreatoscopy procedure
Intermittent fluoroscopic confirmation of the pancreatoscope's position is recommended
Maintain a collapsed duodenal lumen to reduce the amount of intraductal air
Aspirate intraluminal air to minimize the volume of fluid in the pancreatic duct
Avoid suctioning the pancreatic duct wall
Administer rectal diclofenac at the start of the procedure as prophylaxis for post-pancreatoscopy pancreatitis

Table 2 Comparison of electrohydraulic lithotripsy and laser lithotripsy

Feature	Electrohydraulic lithotripsy	Laser lithotripsy
Mechanism	High-pressure shock waves	Laser energy (e.g., holmium)
Efficacy	High fragmentation rate	Higher precision, better control
Tissue injury risk	Higher due to shock waves	Lower due to targeted energy
Preferred for	Hard, larger stones	Smaller, impacted stones

Table 3 Comparison of adverse events in pancreatoscopy and endoscopic retrograde cholangiopancreatography

Adverse event	Pancreatoscopy	Endoscopic retrograde cholangiopancreatography
Post-procedural pancreatitis	4%-17%	3.5%-9.7%
Cholangitis	3.7%	0.5%-3.0%
Bleeding	3.4%	0.3%-9.6%
Perforation	4.3%	0.08%-0.6%
Sedation-related adverse events	Not reported	2%-26%