Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial.

BACKGROUNDS/OBJECTIVES: Patients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones. METHODS: This is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements. CONCLUSIONS: This study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).

Endoscopic treatment of a refractory benign biliary stricture using cholangioscopy-guided thulium laser stricturoplasty.

Video 1Details regarding the patient's clinical presentation and prior endoscopic treatments for common hepatic duct stricture are first described in the video. Next, the video features footage from subsequent ERCP demonstrating the common hepatic duct stricture both fluoroscopically and endoscopically via cholangioscopy, followed by treatment with thulium laser stricturoplasty/dissection. The immediate post-treatment images of the stricture are displayed which demonstrated marked improvement in the stricture. Finally, the patient's ensuing clinical course is displayed in which the stricture recurred and was retreated with laser stricturoplasty/dissection and stent upsizing.

Episodic traces and statistical regularities: Paired associate learning in typical and dyslexic readers.

Learning visual-phonological associations is a key skill underlying successful reading acquisition. However, we are yet to understand the cognitive mechanisms that enable efficient learning in good readers, and those which are aberrant in individuals with developmental dyslexia. Here, we use a repeated cued-recall task to examine how typical and reading-impaired adults acquire novel associations between visual and phonological stimuli, incorporating a looking-at-nothing paradigm to probe implicit memory for target locations. Cued recall accuracy revealed that typical readers' recall of novel phonological associates was better than dyslexic readers' recall, and it also improved more with repetition. Eye fixation-contingent error analyses suggest that typical readers' greater improvement from repetition reflects their more robust encoding and/or retrieval of each instance in which a given pair was presented: whereas dyslexic readers tended to recall a phonological target better when fixating its most recent location, typical readers showed this pattern more strongly when the target location was consistent across multiple trials. Thus, typical readers' greater success in reading acquisition may derive from their better use of statistical contingencies to identify consistent stimulus features across multiple exposures. We discuss these findings in relation to the role of implicit memory in forming new visual-phonological associations as a foundational skill in reading, and areas of weakness in developmental dyslexia.