Diario del páncreas Acceso abierto

Abstracto

Endoscopic Treatment for Pancreatolithiasis with a Novel Nitinol Basket Catheter

Hironao Miyoshi, Kazuo Inui, Yoshiaki Katano, Satoshi Yamamoto, Hironao Matsuura

Objective Pancreatolithiasis is often treated by fragmentation of stones by extracorporeal shock wave lithotripsy, followed by additional endoscopic treatments, such as endoscopic pancreatic sphincterotomy. However, it is difficult to remove minute fragments or protein plugs using the conventional basket catheter. We recently used a newly developed nitinol basket catheter, for endoscopic removal of pancreatic stones. We report the results of our study on the usefulness of this catheter. Patients and methods The subjects were 8 patients with pancreatolithiasis treated by extracorporeal shock wave lithotripsy plus endoscopic treatment at our department between July 2014 and January 2015. There were 7 men and 1 woman, ranging in age from 26 to 86 years (median 46 years). Endoscopic removal of pancreatic stones using the nitinol basket catheter was performed a total of 15 times, and the insertability, success rate of pancreatic stone removal, complications, and pancreatic stone recurrence rate were examined. Results The nitinol basket catheter was easily inserted in 12 (80%) of the 15 sessions. In the remaining 3 sessions, it was difficult to insert the catheter because of narrowing of the main pancreatic duct in the pancreatic head, kinking of the pancreatic duct in the pancreatic head and body, and edema around the papilla present immediately after pancreatic sphincterotomy. The success rate of endoscopic removal of pancreatic stones was 87.5% (7/8 patients), 73% (11/15 sessions). As for complications, mild pancreatitis occurred in 1 session, and mild transient abdominal pain in 2; both complications resolved with conservative treatment. Recurrence of the pancreatolithiasis was found after 8 months in 1 (12.5%) of the 8 patients, who had narrowing of the main pancreatic duct in the pancreatic head. Conclusion The nitinol basket catheter is advantageous for the removal of small pancreatic stones and protein plugs, which are difficult to visualize by pancreatography, and may be useful for preventing recurrence of pancreatolithiasis.