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Li BR et al, 2015: Extracorporeal shock wave lithotripsy is a safe and effective treatment for pancreatic stones coexisting with pancreatic pseudocysts.

Li BR, Liao Z, Du TT, Ye B, Chen H, Ji JT, Zheng ZH, Hao JF, Ning SB, Wang D, Lin JH, Hu LH, Li ZS.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China; Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China; Department of Gastroenterology, Air Force General Hospital, Beijing, China.

Abstract:

BACKGROUND AND AIMS: We aimed to investigate outcomes of pancreatic extracorporeal shock wave lithotripsy (P-ESWL) for the removal of large pancreatic stones coexisting with pancreatic pseudocysts (PPCs) in chronic pancreatitis (CP).

METHODS: This is a prospective study performed in CP patients with at least 1 stone (≥5 mm). Patients were divided into the PPC group (stones coexisting with PPCs) or the control group (stones alone). Patients were initially subjected to successive P-ESWL treatments, followed by ERCP. Primary outcomes were P-ESWL adverse events, and secondary outcomes were stone clearance, long-term pain relief, improved quality-of-life scores, and PPC regression.

RESULTS: A total of 849 patients (59 in the PPC group and 790 in the control group) was subjected to P-ESWL between March 2011 and October 2013. Occurrences of P-ESWL adverse events were similar between the PPC group and the control group (11.86% vs 12.41%, P = .940). After the treatment of initial P-ESWL combined with ERCP, the complete, partial, and nonclearance of stones occurred in 67.24%, 20.69%, and 12.07%, respectively, of patients in PPC group, with no significant difference from the control group (complete, partial, and nonclearance: 83.17%, 10.40%, and 11.39%, respectively; P = .106). Fifty-five of 59 patients (93.22%) with PPCs were followed for a median period of 21.9 months (range, 12.0-45.1). PPCs disappeared in 56.36% (31/55) and 76.36% (42/55) of patients after 3 months and 1 year of follow-up visits, respectively. Moreover, complete and partial pain relief were achieved in 63.64% (35/55) and 25.45% (14/55) of patients, respectively. The scores for quality of life (P < .001), physical health (P < .001), and weight loss (P < .001) improved.

CONCLUSIONS: In our multispecialty tertiary center, initial P-ESWL followed by ERCP was safe in patients with coexisting pancreatic stones and PPCs and effective for stone clearance, main pancreatic duct drainage, and pain relief.

Gastrointest Endosc. 2015 Nov 2. pii: S0016-5107(15)03042-4. doi: 10.1016/j.gie.2015.10.026. [Epub ahead of print]

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Comments 1

Peter Alken on Friday, 06 May 2016 13:14

In the present series “in each patient a P-ESWL session was repeated on consecutive days until the stones were fragmented down to a diameter nge, 1-5] vs 2 [range, 1-12], respectively.”
ESWL for pancreatic stones is done since the late 80ies (Sauerbruch Tet al. Extracorporeal shock wave lithotripsy of pancreatic stones. Gut. 1989 Oct;30(10):1406-11) and is still done today.
I wonder why and how urologists were searching for diabetes after ESWL for renal stones: de Cógáin M, et al. Shock wave lithotripsy and diabetes mellitus: a population-based cohort study. Urology. 2012 Feb;79(2):298-302;
Krambeck AE, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol. 2006
May;175(5):1742-7

In the present series “in each patient a P-ESWL session was repeated on consecutive days until the stones were fragmented down to a diameter nge, 1-5] vs 2 [range, 1-12], respectively.” ESWL for pancreatic stones is done since the late 80ies (Sauerbruch Tet al. Extracorporeal shock wave lithotripsy of pancreatic stones. Gut. 1989 Oct;30(10):1406-11) and is still done today. I wonder why and how urologists were searching for diabetes after ESWL for renal stones: de Cógáin M, et al. Shock wave lithotripsy and diabetes mellitus: a population-based cohort study. Urology. 2012 Feb;79(2):298-302; Krambeck AE, et al. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol. 2006 May;175(5):1742-7
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