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Gurav N. et al., 2024: Predictors of persistent pain after extracorporeal shockwave lithotripsy for painful chronic calcific pancreatitis.

Gurav N, Jagtap N, Koppoju V, Sekhramantri K, Asif S, Tandan M, Lakhtakia S, Kalapala R, Ramchandani M, Talukdar R, Basha J, Nabi Z, Memon SF, Darisetty S, Rao GV, Reddy DN.
Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, India.
Department of Gastrointestinal Anaesthesia, AIG Hospitals, Hyderabad, India.
Department of Surgical Gastroenterology, AIG Hospitals, Hyderabad, India.

Abstract

Background: Extracorporeal shockwave lithotripsy (ESWL) and/or endoscopic retrograde cholangiopancreatography (ERCP) are recommended as first-line therapy for painful uncomplicated chronic pancreatitis with obstructed main pancreatic duct (MPD) in the pancreas head/body. However, predictors of pain relief after ESWL are unknown. We evaluated independent predictors of persistent pain in patients who underwent ESWL for chronic pancreatitis.

Methods: 640 consecutive adult patients with chronic pancreatitis, who underwent successful ESWL with ERCP and pancreatic duct (PD) stent placement, were followed for 12 months. The pain was assessed at baseline and at 12 months using the Izbicki Pain Score, with a score decrease of >50% considered pain relief. Independent predictors of pain relief were derived from logistic regression analysis.

Results: Of 640 patients (mean age 36.71 [SD 12.19] years; 60.5% men), 436 (68.1%) had pain relief and 204 (31.9%) had persistent pain. On univariate analysis, older age, male sex, alcohol and tobacco intake, longer duration of symptoms, dilated MPD and MPD stricture were associated with persistent pain at 12 months (P<0.05). Consumption of alcohol (odds ratio [OR] 1.93, 95%CI 1.26-2.97), tobacco (OR 4.09, 95%CI 2.43-6.90), duration of symptoms (OR 1.02, 95%CI 1.01-1.04), MPD size (OR 1.22, 95%CI 1.11-1.33), and MPD stricture (OR 8.50, 95%CI 5.01-14.42) were independent predictors of persistent pain.

Conclusions: Alcohol, tobacco, duration of symptoms, MPD size and stricture were independent predictors of persistent pain after successful ESWL. A multidisciplinary team approach that includes behavioral therapy and surgical options should be considered for such patients.

Endoscopy. 2024 Feb 21. doi: 10.1055/a-2252-9920. Online ahead of print. PMID: 38267001

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Comments 1

Peter Alken on Wednesday, 19 June 2024 11:00

Since some years we - being urologists and not gastroenterologists - included ESWL of pancreatic stones in our reviews because of our interest in ESWL effects on stones and side effects. It is always surprising how different kidney and pancreas respond to ESWL: “Between 5000 and 6000 shocks were delivered per session, with intensity of 15–16 kV at a frequency
of 90 shocks per minute. Shocks were delivered daily until fragmentation
to isease have been done but I am not aware of similar ones looking at the effects of alcohol and tobacco on nephrolithiasis.

Peter Alken

Since some years we - being urologists and not gastroenterologists - included ESWL of pancreatic stones in our reviews because of our interest in ESWL effects on stones and side effects. It is always surprising how different kidney and pancreas respond to ESWL: “Between 5000 and 6000 shocks were delivered per session, with intensity of 15–16 kV at a frequency of 90 shocks per minute. Shocks were delivered daily until fragmentation to isease have been done but I am not aware of similar ones looking at the effects of alcohol and tobacco on nephrolithiasis. Peter Alken
Friday, 12 July 2024