Letter to the Editor
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2020; 12(9): 317-319
Published online Sep 16, 2020. doi: 10.4253/wjge.v12.i9.317
Do available data support the widespread adoption of pancreatoscopy guided-lithotripsy?
Luca De Luca
Luca De Luca, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Pesaro 61121, Italy
Author contributions: De Luca L contributed alone to the study, he has read and agreed to the published version of the manuscript.
Conflict-of-interest statement: No conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Luca De Luca, MD, Doctor, Gastroenterology and Digestive Endoscopy Unit, Ospedali Riuniti Marche Nord, Piazzale Cinelli 1, Pesaro 61121, Italy. lucadeluca1210@gmail.com
Received: May 29, 2020
Peer-review started: May 29, 2020
First decision: July 21, 2020
Revised: July 23, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: September 16, 2020
Abstract

Peroral pancreatoscopy (POPS) is a demanding endoscopic procedure that can be used to perform intracanal lithotripsy in obstructing pancreatic stones but the experience is limited. Most stones can be removed successfully by endoscopic retrograde cholangio-pancreatography but patients with large stones require advanced therapeutic approaches, such as extracorporeal shock wave lithotripsy (alone or followed by endoscopic retrograde cholangio-pancreatography), currently the mainstay of treatment. Unfortunately, in about 10% of cases, extracorporeal shock wave lithotripsy can fail; moreover, it is not be available in many institutions. For this subgroup of patients, POPS guided-lithotripsy can play a role and have benefits. The most consistent study concerns a retrospective multicenter analysis that enrolled few patients per center. Considering the epidemiological scenario and the scant volume of skilled endoscopists, POPS must be developed in very few high-volume referral centers with standardized pathways and capable of performing multi-modality treatment. In addition, we could reasonably assume that POPS-guided-lithotripsy should be used as rescue therapy in special situations, identifying the ideal candidate who can achieve the maximum clinical result, and carefully balancing risk/benefits ratio.

Keywords: Pancreatic stones, Pancreatoscopy guided-lithotripsy, Rescue therapy, Extracorporeal shock wave lithotripsy, Endoscopic retrograde cholangio-pancreatography, Referral centers

Core Tip: In chronic pancreatitis, the goal of treatment is reducing pain by eliminating obstructing pancreatic stones. There are several minimally invasive treatment approaches, such as extracorporeal shock wave lithotripsy and/or endoscopic retrograde cholangio-pancreatography; but where they fail, more advanced therapeutic techniques can be used. Peroral pancreatoscopy guided-lithotripsy is an appropriate option but should be performed as rescue therapy by experienced endoscopists in very few high-volume referral centers.