Randomized study of extracorporeal shock wave lithotripsy versus pancreatoscopy-guided laser lithotripsy (SpyGlass DS) for pancreatic ductal stones

Pancreatic stones can be managed by surgery, endoscopy, or extracorporeal shock wave lithotripsy. Pancreatic ductal stones have a decreased incidence of successful endoscopic extraction and often require lithotripsy. Many critical patients in whom conventional surgery is a high-risk procedure can be managed by ERCP. Although ERCP with conventional methods is successful in most cases, certain stones are difficult or impossible to manage with these maneuvers. Current guidelines suggest use of extracorporeal shock wave lithotripsy (ESWL) for PD stones. In patients with chronic pancreatitis, ESWL permits stone fragmentation and removal during ERCP with some advantages over laser lithotripsy (LL) and surgery. Recently direct pancreatoscopy using the SpyGlass DS system allows direct visualization of the pancreatic ductal stones and lithotripsy can be performed using Holmium laser. Theoretically this offers several advantages; however, no randomized trials have assessed the usefulness of these modalities or superiority of one over the other. So, we aim to study the outcomes between extracorporeal shock wave lithotripsy versus pancreatoscopy-guided laser lithotripsy (SpyGlass DS) for pancreatic ductal stones in a randomised manner.