Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis
Issued Date
2025-01-01
Resource Type
ISSN
01632116
eISSN
15732568
Scopus ID
2-s2.0-105001696882
Journal Title
Digestive Diseases and Sciences
Rights Holder(s)
SCOPUS
Bibliographic Citation
Digestive Diseases and Sciences (2025)
Suggested Citation
Siranart N., Kozai L., Simadibrata D.M., Pornananrat N., Roongphornchai P., Pajareya P., Worapongpaiboon R., Phutinart S., Dendumrongsup W., Chumpangern Y., Jaroenlapnopparat A., Vantanasiri K., Tantitanawat K. Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis. Digestive Diseases and Sciences (2025). doi:10.1007/s10620-025-08952-w Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/109468
Title
Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis
Corresponding Author(s)
Other Contributor(s)
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.