Guo JY. et al., 2021: Optimal Timing of Endoscopic Intervention After Extracorporeal Shock-Wave Lithotripsy in the Treatment of Chronic Calcified Pancreatitis.
Guo JY, Qian YY, Sun H, Chen H, Zou WB, Hu LH, Li ZS, Xin L, Liao Z.
Department of Gastroenterology, the Second People's Hospital of Karamay, Karamay, Xinjiang Uygur Autonomous Region, China.
Objectives: The interval between extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) may cause differences in cannulation and stone removal. This study was to investigate the optimal timing of ERCP after ESWL.
Methods: Patients with chronic calcified pancreatitis, who underwent ESWL and subsequent ERCP in Changhai Hospital from February 2012 to February 2015, were retrospectively analyzed. The interval between ESWL and ERCP was used to divide patients into groups A (<12 hours), B (12-36 hours), and C (>36 hours). Cannulation success, stone clearance, and post-ESWL/ERCP complications were compared.
Results: A total of 507 patients were enrolled. There were no significant differences regarding the successful cannulation and stone removal rates between the 3 groups. In patients without prior ERCP, the successful cannulation rates were 71.4%, 81.9%, and 90.9% (P = 0.004), and the successful clearance rates were 76.2%, 85.1%, and 90.9% (P = 0.031) for these 3 groups, respectively, showing significant differences. There were no differences in the successful cannulation and stone extraction rates for patients with prior ERCP.
Conclusions: The interval between ESWL and ERCP in chronic calcified pancreatitis patients with prior ERCP is not relevant, while delaying endoscopic intervention is recommended in those with native papilla.
Pancreas. 2021 Apr 1;50(4):633-638. doi: 10.1097/MPA.0000000000001810. PMID: 33939679.
This retrospective study of a large patient group fails to answer the question what the optimal time is for endoscopic intervention after ESWL: in multivariate analysis only pancreatic duct morphology but not time was recognized as risk factor for successful cannulation and stone removal; in addition the retrospective nature of the study with 128, 161 and 218 group A, B and C patients resp. does not exclude a significant selection bias.