S5376 Novel Single-Use Cholangiopancreatoscope-Guided Electrohydraulic Lithotripsy for Pancreatic and Biliary Stone Management: A Case Series

Introduction: Peroral cholangiopancreatoscopy (POCP) has advanced the management of complex biliary and pancreatic duct stones. However, traditional POCP platforms are limited by a 1.2 mm working channel, restricting the use of larger electrohydraulic lithotripsy (EHL) probes and contributing to premature probe failure, especially with large or resistant stones. The novel POCP (Dragonfly) system offers a larger 1.7 mm working channel, accommodating 4.5 Fr EHL probes, which are 2.4 times larger than the current standard 1.9 Fr probes. This may improve probe durability and lithotripsy efficiency. This case series describes our initial experience using the novel POCP system for management of complex pancreatic and biliary stones. Case Description: Three patients underwent POCP-guided EHL using the Dragonfly system. The procedures were performed by 2 experienced endoscopists. A 46-year-old man and an 86-year-old man with chronic calcific pancreatitis and pancreatic duct stones, underwent EHL with successful fragmentation and duct clearance using balloon and basket sweeps, followed by pancreatic duct stent placement. The procedure duration was 128 and 89 minutes, respectively. A third patient, a 24-year-old woman with a malignant Bismuth type IV stricture and concurrent choledocholithiasis, underwent successful EHL of common bile duct stones, with complete stone clearance achieved with balloon extraction, followed by plastic stent placement during a 79-minute procedure. Technical success with complete stone fragmentation was achieved in a single session for all cases. There were no periprocedural adverse events, and all patients were discharged home after the procedure. Post-procedure, the performing endoscopists completed a device performance evaluation using a Likert scale of 1-5 (5 representing the highest score). In all cases, the 4.5 Fr EHL probe passed smoothly through the novel POCP (median Likert score = 5), and the system provided excellent visualization (median Likert score = 5) and maneuverability (median Likert score = 5). Discussion: This novel POCP system demonstrated feasibility and safety in treating both pancreatic and bile duct stones with EHL. The larger working channel accommodated higher-capacity probes without technical difficulty and facilitated single-session stone clearance.