Abdul S. et al., 2025: The risk factors affecting effect of extracorporeal shock wave lithotripsy for pancreatic duct stones.

Sammad Abdul, Xiaofei Jiao, Chunying Wu 
BMC Gastroenterol. 2025 May 3;25(1):333. doi: 10.1186/s12876-025-03801-6 FREE PAPER

Abstract

Objectives: This study aimed to investigate the factors affecting effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.

Materials and methods: The data of 160 patients who underwent ESWL for pancreatic duct stones in Department of Gastroenterology, First People's Hospital of Hangzhou, Westlake University School of Medicine, from July 2017 to June 2023, were retrospectively analyzed. The age and sex of the patients were recorded. All patients underwent spiral computed tomography (CT) abdominal plain scan. The placement of the pancreatic duct stent was recorded. The maximum CT value of stones was manually measured. The regions of interest (ROI) was delineated using ITK-SNAP software, and the stone volume was recorded. According to the size of residual stones after lithotripsy, 99 patients were included in the complete lithotripsy group (CL Group) and 61 patients in the incomplete lithotripsy group (ICL Group). SPSS 26.0 software was used for processing and analysis. A P value < 0.05 was considered statistically significant.

Results: The Sex, maximum CT value, and volume of pancreatic duct stones were statistically significant in both groups. Binary logistic regression analysis showed that female sex, maximum CT value, and volume of pancreatic duct stones were independent risk factors affecting incomplete ESWL fragmentation in pancreatic duct stones. ICL group had a higher mean number of treatments and mean number of impacts than CL group.

Conclusion: The Sex, maximum CT value, and volume of stones were related to the therapeutic effect of ESWL. Female sex, maximum CT value, and volume of stones were independent risk factors affecting incomplete stone fragmentation.

Comment Hans-Göran Tiselius

This report comprises 160 patients treated with SWL for pancreatic duct stones. The focus of the message was to identify risk factors or rather determinants of the outcome of SWL. This information is not commonly found in literature and therefore the results are of certain interest.
Two patient groups were identified: complete lithotripsy (C) and incomplete lithotripsy (IC).
The 99 patients in group C were all treated with only one SWL session whereas in average 2.23 sessions were recorded for the 61 IC-patients. It is, however, not possible to understand if the additional SWL sessions improved the result or if they all were without effect. Details on the degree of disintegration at the time of follow-up are not given.
The basic conclusions were that female gender, stone density (high HU) and large stone volume increased the risk of insufficient disintegration / clearance. The gender difference was explained by a more commonly disturbed function of sphincter Oddi in women, but if this really was the reason is unknown.
It is also unknown how often ERCP was used to improve stone clearance and how often this method affected the outcome.
This is a relatively large number of SWL-treated patients in one institution, hopefully treated with standardized methodology for stone disintegration and elimination of pancreatic duct stones/fragments.
It had been interesting to learn more about the stepwise achievements of treatment progress, also including potential difficulties to focus pancreatic stones.

Hans-Göran Tiselius