Hao L et al., 2018: Extracorporeal shock wave lithotripsy is safe and effective for geriatric patients with chronic pancreatitis
Hao L, Liu Y, Wang T, Guo HL, Wang D, Bi YW, Xin L, He L, Lin JH, Zhang D, Zeng XP, Zou WB, Chen H, Xie T, Li BR, Cong ZJ, Wang LS, Liao Z, Xu ZL, Li ZS, Hu LH.
Department of Gastroenterology, Hainan Branch of Chinese PLA General Hospital, Sanya, China. Gongli Hospital, The Second Military Medical University, Shanghai, China. Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China. Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China. Air Force General Hospital, Beijing, China. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China.Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, China.
BACKGROUND & AIMS: Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is first-line treatment for chronic pancreatitis (CP) patients with pancreatic stones. However, the performance of P-EWSL in geriatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for them. METHODS: This prospective study was conducted in painful CP patients who underwent P-ESWL. Patients aged over 65 years were included in geriatric group; patients aged under 65 years were assigned to control group. For the long-term follow-up investigation, geriatric patients were matched with patients from the control group in a 1:1 ratio. Primary outcomes were complications of P-ESWL and pain relief. Secondary outcomes included: stone clearance, physical and mental health, quality of life score, changes in exocrine and endocrine pancreatic function, and survival. RESULTS: From March 2011 to March 2016, P-ESWL was performed in 1,404 patients (72 in the geriatric group, 1,332 in the control group). No significant differences were observed in complications of P-ESWL between the two groups (P = 0.364). Among the 67 (67/72, 93.1%) geriatric patients who underwent follow-up for 4.02 years, complete pain relief was achieved in 53 patients, which was not significantly different from that of matched controls (54/70; P = 0.920). The death in the geriatrics was significantly higher (P = 0.007), but none of them were correlated with P-ESWL. CONCLUSIONS: P-ESWL is safe and effective for geriatric CP patients with pancreatic stones. It can promote significant pain relief and stone clearance, and improve quality of life, mental and physical health.
J Gastroenterol Hepatol. 2018 Dec 14. doi: 10.1111/jgh.14569. [Epub ahead of print]
The long term outcome is evaluated in a matched pair analysis of 72 geriatric group patients with 72 of 1322 patients from the control group. The matching principles were rather soft: sex, type of abdominal pain, and location of the stone. Authors did not mention the STROBE or CONSORT criteria.
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