EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY OF PANCREATIC DUCT STONES USING THE HEALTHTRONICS LITHOTRON LITHOTRIPTOR AND THE DORNIER HM3 LITHOTRIPSY MACHINE (original) (raw)
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Extracorporeal shock wave lithotripsy for pancreatic duct stones: an observational study
Scandinavian Journal of Gastroenterology, 2018
Introduction: Previous studies suggest that fragmentation of pancreatic duct stones (PDS) using extracorporeal shock wave lithotripsy (ESWL) is associated with pain relief. However, the treatment may not be effective in certain subgroups. Aim: To evaluate predictors of pain relief after ESWL in patients with chronic pancreatitis and PDS. Methods: Retrospective study including patients with chronic pancreatitis undergoing ESWL for painful PDS. Analgesic use before and after the ESWL procedure was registered. We defined adequate pain relief after ESWL as 'pain-free without analgesics or with use of weak analgesics as needed'. The study was approved by the Danish Data Protection Agency (approval number: AHH-2017-048). Results: We included 81 patients (median age 58 years; 63% men; 68% alcoholic pancreatitis). Patients underwent one to seven ESWL procedures (mean 1.7). A concurrent ERCP was performed in 17%. All patients used analgesics before the ESWL procedure (68 used opioids). After ESWL, 43 still used opioids. Thirty-two patients achieved adequate pain relief. Univariable regression analysis showed that older age predicted adequate pain relief (OR 1.09;1.03-1.16; p ¼ .002) as did location of the stone in the head or neck (OR 2.59;1.04-6.45; p ¼ .041). In multivariable analysis, we found that the only two predictors of adequate pain relief were age (p ¼ .002) and the location of the stones (p ¼ .039). Conclusion: After the ESWL, about four out of ten patients are pain-free without medication or able to manage their pain with weak analgesics. Age and the location of the stones may be considered when evaluating if patients are eligible for referral to ESWL.
Pancreas, 2014
Objectives: Patients with chronic pancreatitis are managed by extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. Stone density on noncontrast computed tomography (NCCT) is used to predict stone composition and fragility, but no report investigating the pancreatic stone density has been documented. We aimed to assess the usefulness of pancreatic stone density on NCCT in predicting the ESWL outcome. Methods: We evaluated 128 consecutive patients with pancreatic stones who underwent ESWL. Pancreatic stone density on NCCT was measured in Hounsfield units. Patients with complete stone removal were compared with those with incomplete stone removal. Patient characteristics; imaging findings, including stone density; and interventions were evaluated as potential predictors. The optimal cutoff value of variables to differentiate complete removal from incomplete removal was determined by receiver operating characteristic analysis. Results: Complete stone removal was achieved in 66 patients (51.6%). When the density threshold was set at 820.5 Hounsfield units, complete stone removal was achieved in 52 patients (78.8%) with lower-density stones. In multivariate analysis, single stone (P = 0.007) and lowerdensity stone (P < 0.001) revealed significant association with complete stone removal. Conclusions: The measurement of pancreatic stone density before therapy can help predict therapeutic outcomes.
Extracorporeal shockwave lithotripsy of pancreatic duct stones
Gastrointestinal Radiology, 1992
Extracorporeal shock wave lithotripsy of pancreatic stones was performed in eight patients with chronic pancreatitis and a dilated duct system harbouring stones 5 to 20 mm (3x 10 (SD) 5 mm) in diameter. After endoscopic sphincterotomy of the pancreatic orifice the stones were disintegrated by shock waves under fluoroscopic control using a kidney lithotripter (Dornier HM3). The procedure was well tolerated by all but one patient, who had a mild pancreatitic attack immediately after lithotripsy. Clearance of the pancreatic duct systems from the larger stones was achieved in seven of eight patients. Half of the patients showed no improvement in the intensity and frequency of pain. The other patients had a marked amelioration of symptoms, however, both immediately and during a mean follow up interval of 11 (eight) months. A selective combined approach by endoscopy and extracorporeal shock wave lithotripsy for the treatment of pancreatic stones seems promising.
Gut, 1997
Background and aims-To compare extracorporeal shock wave lithotripsy (ESWL) and laser induced shock wave lithotripsy (LISL) of retained bile duct stones to stone free rate, number of therapeutic sessions, and costs. Patients-Thirty four patients were randomly assigned to either ESWL or LISL therapy. The main reasons for failure of standard endoscopy were due to stone impaction (n=12), biliary stricture (n=8), or large stone diameter (n=14). Methods-An extracorporeal piezoelectric lithotripter with ultrasonic guidance and a rhodamine 6G laser with an integrated stone tissue detection system were used. LISL was performed exclusively under radiological control. Results-Using the initial methods complete stone fragmentation was achieved in nine of 17 patients (52.4%) of the ESWL group and in 14 of 17 patients (82-4%) in the LISL group, or combined with additional fragmentation techniques 31 of the 34 patients (91 2%) were stone free at the end of treatment. In comparison LISL tended to be more efficient in clearing the bile ducts (p=0.07, NS). Significantly less fragmentation sessions (1-29 v 2-82; p=0O0001) and less additional endoscopic sessions (0.65 v 1'6; p=0.002) were necessary in the LISL group. There were no major complications in either procedure. Conclusions-Compared with ESWL, fluoroscopically guided LISL achieves stone disintegration more rapidly and with significantly less treatment sessions, which leads to a significant reduction in cost.
Gut, 1992
Extracorporeal shock wave lithotripsy of pancreatic duct stones (largest stone 12 (SD) 6 mm) was performed in 24 patients with abdominal pain and a dilated duct system (main pancreatic duct 10 (3) mm). The procedure was well tolerated in all but two patients, who had a mild pancreatitic attack immediately after lithotripsy. Disintegration of the stones was achieved in 21 patients. This allowed complete clearance of the duct system by an endoscopic approach in 10 (42%) patients and partial clearance in 7 (29%) patients. Within a mean follow up period of 24 (14) months half of the patients showed complete or considerable relief of pain and alleviation of symptoms was achieved in seven patients. Relief of pain occurred more often after complete ductal clearance. There were no fatalities within the follow up period. These Medical Department II, findings underline the value of a combined Klinikum Grofihadern, non-surgical approach, using endoscopy and University of Munich, adjuvant shock wave lithotripsy to patients Munich, Germany with large pancreatic calculi and pain attacks.
Journal of Translational Internal Medicine, 2020
Background and Objective: Extracorporeal shock wave lithotripsy (ESWL) for common bile duct (CBD) stones has been used in the past, but experience is limited. We report our experience of ESWL in the management of difficult CBD stones. Methods: Patients with difficult-to-retrieve CBD stones were enrolled and underwent ESWL. Fluoroscopy is used to target the stones after injection of contrast via nasobiliary drain. CBD clearance was the main outcome of the study. Results: Eighty-three patients were included (mean age 50.5 ± 14.5 years); these patients were mainly females (43; 51.8%). Large stones >15 mm were noted in 64 (77.1%), CBD stricture in 22 (26.5%) and incarcerated stone in 8 (9.6%) patients. Patients needed 2.1 ± 1.2 sessions of lithotripsy and 4266 ± 1881 shock waves per session. In 75 (90.3%) patients, the fragments were extracted endoscopically after ESWL, while spontaneous passage was observed in 8 (9.6%). Total CBD clearance was achieved in 67 (80.6%) patients, partial clearance in 5 (6%) and no response in 11 (13.2%). Failure of the treatment was observed in large stone with size ≥2 cm (P = 0.021), incarcerated stone (P = 0.020) and pre-endoscopic retrograde cholangiopancreatography cholangitis (P = 0.047). Conclusion: ESWL is a noninvasive, safe and effective therapeutic alternative to electrohydraulic lithotripsy and surgical exploration for difficult biliary stones.
Stone technology: intracorporeal lithotripters
World Journal of Urology, 2017
Mechanical lithotripters include ballistic lithotripters as well as the manually operated bladder calculus fragmenters which were the first lithotripters to be developed. The history of lithotripsy began in the early 1800s with physicians attempting intravesical means of treating stones. Franz von Gruithuisen developed the first model of a functioning lithotrite, the Steinbohrer or stone drill in 1813. It was designed to drill holes into bladder calculi [3]. The term lithotrite was coined by Jean Civiale who developed the Abstract Purpose Intracorporeal lithotripsy is becoming the most commonly used surgical method of stone treatment in Urology. The five major types of intracorporeal lithotripters are ultrasonic, ballistic, and combination lithotripters as well as laser and electrohydraulic lithotripters. The advantages and disadvantages of choosing each of these treatment modalities are reviewed. Methods Extensive review of literature was performed to identify the types of intracorporeal lithotripters. An investigation was undertaken of the early development of each modality of intracorporeal lithotripsy and/or the mechanism of action. Challenges of each technique were identified and presented. Finally, a determination was made of how these lithotripters compare on the basis of effectiveness of action and cost based on information provided in primary literature as well as previous reviews of these modalities. Results Contemporary lithotripters have found widespread use in the management of urinary lithiasis. Holmium laser lithotripsy has become one of the most commonly used tools for intracorporeal lithotripsy. Conclusion There is a wide variety of intracorporeal lithotripters which can be chosen based on the characteristics of each modality and the requirements of the urologist.
Biliary and pancreatic lithotripsy devices
Gastrointestinal Endoscopy, 2007
Background and Aims: Lithotripsy is a procedure for fragmentation or destruction of stones to facilitate their removal or passage from the biliary or pancreatic ducts. Although most stones may be removed endoscopically using conventional techniques such as endoscopic sphincterotomy in combination with balloon or basket extraction, lithotripsy may be required for clearance of large, impacted, or irregularly shaped stones. Several modalities have been described, including intracorporeal techniques such as mechanical lithotripsy (ML), electrohydraulic lithotripsy (EHL), and laser lithotripsy, as well as extracorporeal shock-wave lithotripsy (ESWL). Methods: In this document, we review devices and methods for biliary and pancreatic lithotripsy and the evidence regarding efficacy, safety, and financial considerations. Results: Although many difficult stones can be safely removed using ML, endoscopic papillary balloon dilation (EPBD) has emerged as an alternative that may lessen the need for ML and also reduce the rate of adverse events. EHL and laser lithotripsy are effective at ductal clearance when conventional techniques are unsuccessful, although they usually require direct visualization of the stone by the use of cholangiopancreatoscopy and are often limited to referral centers. ESWL is effective but often requires coordination with urologists and the placement of stents or drains with subsequent procedures for extracting stone fragments and, thus, may be associated with increased costs. Conclusions: Several lithotripsy techniques have been described that vary with respect to ease of use, generalizability, and cost. Overall, lithotripsy is a safe and effective treatment for difficult biliary and pancreatic duct stones. (Gastrointest Endosc 2018;3:329-38.) This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE).