ESWL VS PANCREATOSCOPIC GUIDED LITHOTRIPSY FOR PANCREATIC DUCTAL STONES- A SYSTEMATIC REVIEW.

Abstract

Background: Pancreatic ductal stones are a common complication of chronic pancreatitis, often leading to significant morbidity due to pain and pancreatic dysfunction. While Endoscopic Shock Wave Lithotripsy (ESWL) and Pancreatoscopic Guided Lithotripsy have emerged as mainstays for managing these stones, there is ongoing debate regarding their efficacy and safety. Objective: To systematically compare the efficacy, safety, and patient outcomes associated with ESWL and Pancreatoscopic Guided Lithotripsy in the treatment of pancreatic ductal stones. Methods: This systematic review analysed data from fifteen studies comparing ESWL and Pancreatoscopic Guided Lithotripsy. Relevant databases were searched for studies published up to December 2023, using keywords related to pancreatic stones and lithotripsy techniques. Data on stone clearance rates, complication rates, procedure times, and patient-reported outcomes were extracted and statistically analyzed. Results: Pancreatoscopic Guided Lithotripsy demonstrated a higher stone clearance rate (85%) compared to ESWL (78%), with a statistically significant difference (P = 0.045). It also showed lower overall complication rates (10% vs. 15%, P = 0.037) and required shorter procedure times and fewer additional procedures. Both methods showed similar rates of severe complications. Additionally, patient-reported outcomes favored Pancreatoscopic Guided Lithotripsy, significantly improving pain relief and quality of life. Conclusion: Pancreatoscopic Guided Lithotripsy appears to be more effective and safer than ESWL in the management of pancreatic ductal stones, with better patient satisfaction regarding pain and quality of life. These findings support the preferential use of Pancreatoscopic Guided Lithotripsy in clinical practice, especially in centers equipped with the necessary expertise and technology. However, individual patient characteristics and local resource availability should guide treatment selection.