Efficacy and Safety of Pancreatoscopy-guided Laser Lithotripsy Versus Electrohydraulic Lithotripsy in Managing Pancreatic Duct Stone: A System Review and Meta-analysis

Objectives: For refractory pancreatic duct stones (PDS), per-oral pancreatoscopy (POP)-guided laser lithotripsy (LL) and electrohydraulic lithotripsy (EHL) are therapeutic options, but their comparative efficacy and safety remain unclear. This meta-analysis aimed to directly compare these two techniques. Methods: A systematic search was conducted across four databases. Studies reporting on POP-guided LL or EHL for PDS were included. Primary outcomes were technical and clinical success rates; secondary outcomes included adverse events (AEs). Pooled proportions were analyzed using random-effects models. Results: Fourteen studies (326 patients: 106 LL, 220 EHL) were included. No significant differences were found between LL and EHL in technical success (78.9% vs. 87.0%; P =0.433), clinical success (86.5% vs. 85.0%; P =0.728), or AE rates (8.8% vs. 10.0%; P =0.726). Substantial heterogeneity was observed for technical success. Publication bias was detected for this outcome. Conclusions: This comparative meta-analysis suggests that POP-guided LL and EHL have comparable efficacy and safety for managing refractory PDS. The choice may depend on operator expertise and available resources. Future randomized trials are warranted to confirm these findings.