Pancreatic duct stones and laser treatment: A case report

A 62 years-old Caucasian male, who had a consumptive condition associated with recurrent episodes of abdominal pain, was evaluated in a Gastroenterology consultation. Physical examination was quite innocent and the following imaging exams were performed. A Computed Tomography (CT) showed a thin gallbladder and chronic pancreatitis signs with pancreatic intraductal stones, dominant at tail and body, associated with pancreatic tail atrophy. An abdominal-Magnetic Resonance Imaging (MRI) showed an abnormal pancreatic parenchyma, a mild Wirsung dilatation and an unknown pancreatic head stenosis etiology. Therefore, to clarify the pancreatic stenosis, an echo-endoscopy (EUS) was performed. This exam showed a 10-mmstone associated with a focal narrowing in the head/tail transition. A pancreatoscopy-guided holmium laser using a mini-endoscope inserted into the pancreatic duct successfully broke the impacted stone and cleared the obstruction, without complications. After that, endotherapy with plastic stents was repeatedly done, during the following 6 months. After endoscopic treatment, the patient recovered quite well, without any symptoms, without pancreatic stenosis and higher quality of life.

The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis

Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed

Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey

Background and aims Indirect peroral cholangiopancreatoscopy (IPOC) is a relatively new diagnostic and therapeutic tool for biliopancreatic diseases. This international survey aimed to evaluate clinical practice patterns in IPOC among endoscopists in Europe. Methods An online survey was developed comprising 66 questions on the use of IPOC. Questions were grouped into four domains. The survey was sent to 369 endoscopists who perform IPOC. Results 86 respondents (23.3 %) from 21 different countries across Europe completed the survey. The main indications for cholangioscopy were determination of biliary strictures (85 [98.8 %]) and removal of common bile duct or intrahepatic duct stones (79 [91.9 %]), accounting for an estimated use of 40 % (interquartile range [IQR] 25–50) and 40 % (IQR 30–60), respectively, of all cases undergoing cholangioscopy. Pancreatoscopy was mainly used for removal of pancreatic duct stones (68/76 [89.5 %]), accounting for an estimated use of 76.5 % (IQR 50–95) of all cases undergoing pancreatoscopy. Only 13/85 respondents (15.3 %) had an institutional standardized protocol for targeted cholangioscopy-guided biopsy sampling. IPOC with lithotripsy was used as first-line treatment in selected patients with bile duct stones or pancreatic stones by 24/79 (30.4 %) and 53/68 (77.9 %) respondents, respectively. Conclusions This first European survey on the clinical practice of IPOC demonstrated wide variation in experience, indications, and techniques. These results emphasize the need for prospective studies and development of an international consensus guideline to standardize the practice and quality of IPOC.

Successful Surgical Removal of Firmly Impacted Pancreatic Duct Stent: Two Case Report

Successful surgical removal of firmly impacted pancreatic duct stent: Two case report Recently, the self-expandable metallic and plastic stents are increasingly being used for management of different pancreatic disorders. The major indications for pancreatic stent placement are: pancreatic duct stones, chronic pancreatitis, pancreatic strictures, unresectable pancreatic cancer, preventing POPF and post-ERCP pancreatitis, papillary adenoma. Stent placement or retrieval and exchange is difficult process and sometimes it could be the serious clinical challenge. We report two cases of successful removal of firmly impacted pancreatic duct stent by open surgical intervention and transduodenal approach with lateral “side-to-side” pancreaticojejunostomy to prevent the risk of main pancreatic duct restenosis in the first case and with the sphincteroplasty in the second. Therefore, in these challenging cases of firmly impacted pancreatic duct stents, our choice seems to be the most optimal and effective surgical procedure, which could be considered like “parachute” option after failed attempts of stents removal by endoscopic and radiological procedures.

Successful Surgical Removal of Firmly Impacted Pancreatic Duct Stent: Two Case Report

Successful surgical removal of firmly impacted pancreatic duct stent: Two case report Recently, the self-expandable metallic and plastic stents are increasingly being used for management of different pancreatic disorders. The major indications for pancreatic stent placement are: pancreatic duct stones, chronic pancreatitis, pancreatic strictures, unresectable pancreatic cancer, preventing POPF and post-ERCP pancreatitis, papillary adenoma. Stent placement or retrieval and exchange is difficult process and sometimes it could be the serious clinical challenge. We report two cases of successful removal of firmly impacted pancreatic duct stent by open surgical intervention and transduodenal approach with lateral “side-to-side” pancreaticojejunostomy to prevent the risk of main pancreatic duct restenosis in the first case and with the sphincteroplasty in the second. Therefore, in these challenging cases of firmly impacted pancreatic duct stents, our choice seems to be the most optimal and effective surgical procedure, which could be considered like “parachute” option after failed attempts of stents removal by endoscopic and radiological procedures.