TOPLINE:

Peroral pancreatoscopy-guided electrohydraulic lithotripsy (POPS-EHL) led to complete fragmentation of pancreatic duct stones in most patients with chronic pancreatitis. However, those with stones > 12.8 mm or with a median value of CT attenuation exceeding 2050 Hounsfield units (HU) were more likely to require extracorporeal shock wave lithotripsy (ESWL) after POPS-EHL.

METHODOLOGY:

• In chronic pancreatitis, ESWL is widely used for treating large pancreatic duct stones but often requires repeated sessions and does not provide intraductal visualization. POPS-EHL is a recently developed technique that provides direct visualization and fragmentation of targeted stones; however, the optimal clinical selection criteria between these two treatments remain uncertain.
• Researchers conducted a retrospective study to evaluate the efficacy and limitations of POPS-EHL and identify preprocedural indicators of incomplete fragmentation in 52 patients with pancreatic duct stones who underwent POPS-assisted treatment at a hospital in Japan between 2017 and 2025.
• Those with a main pancreatic duct stone measuring at least 5 mm were included; the number and maximum diameter of pancreatic duct stones were assessed using CT prior to the POPS procedure.
• Technical success was defined as complete fragmentation of stones < 5 mm, enabling endoscopic removal without additional ESWL.

TAKEAWAY:

• Insertion of a peroral pancreatoscope via the main pancreatic duct was successful in 47 patients, of whom 34 (median age, 60 years; 27 male) underwent POPS-EHL; most (67.6%) patients experienced complete fragmentation of stones, whereas the remaining required additional ESWL due to incomplete fragmentation.
• Incompletely fragmented stones that required additional ESWL had a higher median value of CT attenuation (2238 HU vs 1656 HU) and a larger median diameter (13.1 mm vs 11.2 mm; P < .05 for both) than the completely fragmented stones.
• A CT attenuation value exceeding 2050 HU (odds ratio [OR], 21.6) and stone size > 12.8 mm (OR, 9.26) independently predicted incomplete fragmentation that required ESWL after POPS-EHL, with area under the receiver operating characteristic curve values of 0.854 and 0.775, respectively (P < .05 for both).
• Adverse events were limited to mild-to-moderate postprocedural pancreatitis, and no severe pancreatitis or other major complications were reported.

IN PRACTICE:

“Our study demonstrates that CT-based predictors of incomplete fragmentation provide clinically meaningful guidance for treatment selection. A strategy that incorporates both stone size and attenuation has the potential to improve procedural efficiency, reduce treatment failures, and ultimately enhance outcomes for patients with chronic pancreatitis complicated by pancreatic duct stones,” the authors of the study wrote.

SOURCE:

The study was led by Michihiro Yoshida, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan. It was published online in Digestive Diseases and Sciences.

LIMITATIONS:

The study’s single-center, retrospective design and modest sample size potentially limited generalizability. The degree of stone fragmentation and decisions about repeated EHL sessions were not based on predefined protocols. Additionally, the study did not evaluate long-term outcomes such as sustained pain relief, recurrence of stones, or exocrine and endocrine pancreatic functions.

DISCLOSURES:

No funding information was provided for the study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.