P0021 (S0027). - Predictors of Technical Success and Lower Procedure Burden for Single Operator Pancreatoscopy With Intraductal Lithotripsy vs Extracorporeal Shock Wave Lithotripsy Approaches for Large Main Pancreatic Duct Stones
Indiana University School of Medicine Indianapolis, IN
Benjamin L. Bick, MD, Feenalie Patel, MD, Jeffrey J. Easler, MD, James Watkins, MD, Mark A. Gromski, MD, Evan L. Fogel, MD, Glen A. Lehman, MD, Stuart Sherman, MD; Indiana University School of Medicine, Indianapolis, IN
Introduction: Obstructive main pancreatic duct stones (MPDS) complicate chronic pancreatitis (CP), contributing to disabling symptoms. Large MPDS (≥5 mm) are difficult to extract and typically require lithotripsy with either single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL). This study aims to identify predictors for successful and efficient MPDS clearance of CP patients for SOPIL or ESWL approaches. Methods: We retrospectively identified CP patients from 9/2013 to 9/2019 who underwent SOPIL or ESWL for MPDS therapy at our center. Electrohydraulic lithotripsy (EHL) was used for SOPIL. Success was defined as >80% stone fragmentation and clearance; efficient MPDS clearance was performed with ≤2 procedures. Total procedures needed for MPDS clearance included discrete lithotripsy sessions and subsequent ERCP procedures to clear stones. Same session SOPIL and ERCP were considered 1 procedure. Possible predictors identified in univariate logistic regression models were subsequently used in multivariable logistic regression models, with significance defined as p-value < 0.05. Results: Of the 217 MPDS patients managed with lithotripsy, 18 underwent SOPIL and 199 underwent ESWL. Technical success was similar between SOPIL and ESWL (88.9% vs 86.9%, p=0.813). Efficient MPDS clearance was achieved in 96/189 (50.8%). In a regression model for predictors of technical success (Table 1), endocrine insufficiency, prior pancreatic sphincterotomy, PD stent placement before lithotripsy, PD stricture, stone number, and stone size were possible predictors. On multivariable analysis, only the presence of a downstream PD stricture predicted success (OR 2.650 [1.106-6.351], p=0.029). In a regression model predicting efficient MPDS clearance (Table 2), lithotripsy method, endocrine insufficiency, prior pancreatic sphincterotomy, downstream stone location, stone number, stone size, and PD diameter were possible predictors. On multivariable analysis, SOPIL approach (OR 13.387 [1.632-109.81], p=0.016) was associated with efficient MPDS clearance while a single (large) stone (OR 0.404 [0.182-0.898], p=0.026) was associated with a greater procedure burden. Discussion: SOPIL and ESWL were both effective at MPDS clearance, but a SOPIL approach was associated with fewer procedure sessions and lower resource utilization. If validated in prospective studies, SOPIL may be the preferred method of lithotripsy for select MPDS.
Table 1. Univariate and multivariable logistic regression model assessing predictors of technically successful stone clearance in patients who underwent single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL)
Table 2. Univariate and multivariable logistic regression model assessing predictors of the ability to use 2 or fewer procedures to successfully clear stones in patients who underwent single operator pancreatoscopy with intraductal lithotripsy (SOPIL) or extracorporeal shock wave lithotripsy (ESWL)
Disclosures: Benjamin Bick indicated no relevant financial relationships. Feenalie Patel indicated no relevant financial relationships. Jeffrey Easler: Boston Scientific – Consultant. James Watkins indicated no relevant financial relationships. Mark Gromski: Boston Scientific – Consultant. Evan Fogel indicated no relevant financial relationships. Glen Lehman: Cook Medical – Consultant. Stuart Sherman: Boston Scientific – Consultant. Cook Medical – Consultant. Olympus – Consultant.