Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis

Abstract

Introduction: Pancreatic duct stones (PDS) pose a significant clinical challenge, and choosing treatment modality is crucial to achieving optimal outcomes. Extracorporeal shock wave lithotripsy (ESWL) has long been regarded as the primary intervention for PDS. However, per-oral pancreatoscopy-guided lithotripsy (POP), both electrohydraulic lithotripsy (EHL-POP) and laser lithotripsy (LL-POP), has emerged as a promising endoscopic alternative. This meta-analysis compares the efficacy and safety profiles of EHL-POP, LL-POP, and ESWL for treating PDS.

Methods: A search of MEDLINE, EMBASE, and Cochrane databases until November 2023 was conducted to identify studies assessing the use of EHL-POP, LL-POP, or ESWL for the treatment of PDS. Primary outcomes were technical success and clinical success of stones. Secondary outcomes were any adverse events (AEs) and the incidence of post-intervention pancreatitis.

Results: A total of 45 observational studies were included. Among the 9624 patients with PDS analyzed, 373 underwent POP (238 EHL-POP and 135 LL-POP), while 9,251 underwent ESWL. The pooled technical and clinical success rates of ESWL versus POP were 85.5% (95% CI: 79.1-90.2%) vs. 88.1% (95% CI: 75.1-94.8%) (p = 0.66) and 78.5% (95% CI: 70.9-84.5%) vs. 81.6% (95% CI: 65.1-91.4%) (p = 0.69), respectively. The pooled technical success rate of EHL-POP was 85.2% (95% CI: 68.5-93.9%, I² = 63%), which was comparable to LL-POP at 92.7% (95% CI: 64.4-98.9%, I² = 0%) (p = 0.48). The clinical success rates of EHL-POP and LL-POP were 74.4% (95% CI: 50.7-89.2%, I² = 48%) and 85.7% (95% CI: 63.9-95.3%, I² = 68%), respectively (p = 0.38). The rates of any adverse events and post-intervention pancreatitis for ESWL vs. POP were 10.1% (95% CI: 5.5-17.6%, I² = 95%) vs. 9.3% (95% CI: 4.1-19.6%, I² = 55%) (p = 0.87) and 4.3% (95% CI: 3.1-5.9%, I² = 85%) vs. 2.8% (95% CI: 1.3-6.1%, I² = 0%) (p = 0.32), respectively.

Conclusion: Both EHL-POP and LL-POP, emerges as highly effective and safe alternatives for managing PDS, with safety profiles comparable to ESWL. POP could be considered as an alternative first-line option to ESWL for PDS.

Keywords: Electrohydraulic lithotripsy; Extracorporeal shock wave lithotripsy; Laser lithotripsy; Pancreatic duct stones; Per-oral pancreatoscopy-guided lithotripsy.