STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Dalal A. et al., 2024: Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy.

Dalal A, Kamat N, Maydeo A, Patil G, Vadgaonkar A, Parekh S, Vora S.
Institute of Gastrosciences, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India.

Abstract

Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.

Endosc Int Open. 2024 Feb 28;12(2):E274-E281. doi: 10.1055/a-2226-1464. eCollection 2024 Feb.
PMID: 38420153 FREE PMC ARTICLE

0
 

Comments 1

Peter Alken on Thursday, 30 May 2024 11:00

This paper sends a sad message in 2023 as it shows that experience made in one speciality -urology- are not readily transferred to another- gastroenterology - for the benefit of patients: “The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored.” (1).
ESWL is an important option in the treatment of pancreatic stones: In 2010 a review collected the experience of 1208 ESWL treatments of pancreatic stones dating back as far 1992 (2).
Like in Urology with urinary tract stones, experience with ESWL of pancreatic stones, has shown that some stones respond better or worse to shockwave treatment. There is a plethora of clinical and experimental data in Urology on the impact of CT imaging signalizing the amenability of stones to respond to ESWL not only based on stone density but also on chemical composition and stone structure. A recent review summarized the relevant experience in 4,206 urological patients (3)
The 2012 Gastroenterological guideline (4) did not mention stone density as an important tool to decide about the treatment or inform the patient. The 2018 guideline update (5) only briefly mentioned stone density and reference a single publication on the topic (6) which stated in 2015 “To our knowledge, there has been no report regarding pancreatic stone attenuation values on NCCT.”
The present paper seems to be the 4th on the importance of stone density to evaluate pancreatic stone patients in Gastroenterology. Early sharing and exchanging experience could save time, money and therapeutic failures and should help to improve our patient care.
See also (7) and (8).




1 Dalal A, Kamat N, Maydeo A, Patil G, Vadgaonkar A, Parekh S, Vora S. Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy. Endosc Int Open. 2024 Feb 28;12(2):E274-E281. doi: 10.1055/a-2226-1464. PMID: 38420153; PMCID: PMC10901651.

2 Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):281-98. doi: 10.1016/j.bpg.2010.03.002. PMID: 20510829.

3 Garg M, Johnson H, Lee SM, Rai BP, Somani B, Philip J. Role of Hounsfield Unit in Predicting Outcomes of Shock Wave Lithotripsy for Renal Calculi: Outcomes of a Systematic Review. Curr Urol Rep. 2023 Apr;24(4):173-185. doi: 10.1007/s11934-023-01145-w. Epub 2023 Feb 21. PMID: 36802317; PMCID: PMC10038959.


4 Dumonceau JM, Delhaye M, Tringali A, Dominguez-Munoz JE, Poley JW, Arvanitaki M, Costamagna G, Costea F, Devière J, Eisendrath P, Lakhtakia S, Reddy N, Fockens P, Ponchon T, Bruno M. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2012 Aug;44(8):784-800. doi: 10.1055/s-0032-1309840. Epub 2012 Jul 2. PMID: 22752888.

5 Dumonceau JM, Delhaye M, Tringali A, Arvanitakis M, Sanchez-Yague A, Vaysse T, Aithal GP, Anderloni A, Bruno M, Cantú P, Devière J, Domínguez-Muñoz JE, Lekkerkerker S, Poley JW, Ramchandani M, Reddy N, van Hooft JE. Endoscopic treatment of chronic pancreatitis: European Society of

Gastrointestinal Endoscopy (ESGE) Guideline - Updated August 2018. Endoscopy. 2019 Feb;51(2):179-193. doi: 10.1055/a-0822-0832. Epub 2019 Jan 17. PMID: 30654394.
Free article

6 Ohyama H, Mikata R, Ishihara T, Tsuyuguchi T, Sakai Y, Sugiyama H, Yasui S, Ishii K, Itoh S, Nishikawa T, Watanabe Y, Yokosuka O. Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones. Pancreas. 2015 Apr;44(3):422-8. doi: 10.1097/MPA.0000000000000277. PMID: 25438070.
7 Predictive Factors Correlated with Successful Early Endoscopic Removal of Pancreaticolithiasis in Chronic Pancreatitis after Extracorporeal Shock Wave Lithotripsy.
Wong T, Pattarapuntakul T, Netinatsunton N, Ovartlarnporn B, Sottisuporn J, Yaowmaneerat T, Attasaranya S, Cattapan K, Sripongpun P.
Diagnostics (Basel). 2024 Jan 12;14(2):172. doi: 10.3390/diagnostics14020172.
PMID: 38248049
Free PMC article.
8 Role of Noncontrast Computed Tomography Parameters in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Upper Urinary Stones Cases: A Meta-analysis. Owen K, Joe W, Ivander A, Palgunadi IN, Adhyatma KP.
Acad Radiol. 2023 Nov 18:S1076-6332(23)00556-1. doi: 10.1016/j.acra.2023.10.021. Online ahead of print. PMID: 37985292
Peter Alken

This paper sends a sad message in 2023 as it shows that experience made in one speciality -urology- are not readily transferred to another- gastroenterology - for the benefit of patients: “The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored.” (1). ESWL is an important option in the treatment of pancreatic stones: In 2010 a review collected the experience of 1208 ESWL treatments of pancreatic stones dating back as far 1992 (2). Like in Urology with urinary tract stones, experience with ESWL of pancreatic stones, has shown that some stones respond better or worse to shockwave treatment. There is a plethora of clinical and experimental data in Urology on the impact of CT imaging signalizing the amenability of stones to respond to ESWL not only based on stone density but also on chemical composition and stone structure. A recent review summarized the relevant experience in 4,206 urological patients (3) The 2012 Gastroenterological guideline (4) did not mention stone density as an important tool to decide about the treatment or inform the patient. The 2018 guideline update (5) only briefly mentioned stone density and reference a single publication on the topic (6) which stated in 2015 “To our knowledge, there has been no report regarding pancreatic stone attenuation values on NCCT.” The present paper seems to be the 4th on the importance of stone density to evaluate pancreatic stone patients in Gastroenterology. Early sharing and exchanging experience could save time, money and therapeutic failures and should help to improve our patient care. See also (7) and (8). 1 Dalal A, Kamat N, Maydeo A, Patil G, Vadgaonkar A, Parekh S, Vora S. Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy. Endosc Int Open. 2024 Feb 28;12(2):E274-E281. doi: 10.1055/a-2226-1464. PMID: 38420153; PMCID: PMC10901651. 2 Nguyen-Tang T, Dumonceau JM. Endoscopic treatment in chronic pancreatitis, timing, duration and type of intervention. Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):281-98. doi: 10.1016/j.bpg.2010.03.002. PMID: 20510829. 3 Garg M, Johnson H, Lee SM, Rai BP, Somani B, Philip J. Role of Hounsfield Unit in Predicting Outcomes of Shock Wave Lithotripsy for Renal Calculi: Outcomes of a Systematic Review. Curr Urol Rep. 2023 Apr;24(4):173-185. doi: 10.1007/s11934-023-01145-w. Epub 2023 Feb 21. PMID: 36802317; PMCID: PMC10038959. 4 Dumonceau JM, Delhaye M, Tringali A, Dominguez-Munoz JE, Poley JW, Arvanitaki M, Costamagna G, Costea F, Devière J, Eisendrath P, Lakhtakia S, Reddy N, Fockens P, Ponchon T, Bruno M. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2012 Aug;44(8):784-800. doi: 10.1055/s-0032-1309840. Epub 2012 Jul 2. PMID: 22752888. 5 Dumonceau JM, Delhaye M, Tringali A, Arvanitakis M, Sanchez-Yague A, Vaysse T, Aithal GP, Anderloni A, Bruno M, Cantú P, Devière J, Domínguez-Muñoz JE, Lekkerkerker S, Poley JW, Ramchandani M, Reddy N, van Hooft JE. Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Updated August 2018. Endoscopy. 2019 Feb;51(2):179-193. doi: 10.1055/a-0822-0832. Epub 2019 Jan 17. PMID: 30654394. Free article 6 Ohyama H, Mikata R, Ishihara T, Tsuyuguchi T, Sakai Y, Sugiyama H, Yasui S, Ishii K, Itoh S, Nishikawa T, Watanabe Y, Yokosuka O. Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones. Pancreas. 2015 Apr;44(3):422-8. doi: 10.1097/MPA.0000000000000277. PMID: 25438070. 7 Predictive Factors Correlated with Successful Early Endoscopic Removal of Pancreaticolithiasis in Chronic Pancreatitis after Extracorporeal Shock Wave Lithotripsy. Wong T, Pattarapuntakul T, Netinatsunton N, Ovartlarnporn B, Sottisuporn J, Yaowmaneerat T, Attasaranya S, Cattapan K, Sripongpun P. Diagnostics (Basel). 2024 Jan 12;14(2):172. doi: 10.3390/diagnostics14020172. PMID: 38248049 Free PMC article. 8 Role of Noncontrast Computed Tomography Parameters in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Upper Urinary Stones Cases: A Meta-analysis. Owen K, Joe W, Ivander A, Palgunadi IN, Adhyatma KP. Acad Radiol. 2023 Nov 18:S1076-6332(23)00556-1. doi: 10.1016/j.acra.2023.10.021. Online ahead of print. PMID: 37985292 Peter Alken
Saturday, 13 July 2024