Lapp RT et al, 2016: Duct Diameter and Size of Stones Predict Successful Extracorporeal Shock Wave Lithotripsy and Endoscopic Clearance in Patients With Chronic Pancreatitis and Pancreaticolithiasis
Lapp RT, Wolf JS Jr, Faerber GJ, Roberts WW, McCarthy ST, Anderson MA, Wamsteker EJ, Elta GH, Scheiman JM, Kwon RS.
From the *Division of Gastroenterology and †Department of Urology, University of Michigan, Ann Arbor, MI.
OBJECTIVES: The need for endoscopic therapy before extracorporeal shock wave lithotripsy (SWL) to facilitate pancreatic duct stone removal is unclear. Predictive factors associated with successful fragmentation and subsequent complete duct clearance are variable. We hypothesize pancreatic duct strictures and large stones, but not pre-SWL endotherapy, correlate with successful fragmentation and complete duct clearance.
METHODS: A retrospective cohort study of patients with pancreaticolithiasis who underwent SWL and endoscopic retrograde cholangiopancreatography between January 2009 and June 2014 was evaluated.
RESULTS: Thirty-seven patients were treated. Technical success (TS) of fragmentation was achieved in 22 patients (60%). Technical success was associated with fewer stones and SWL sessions and smaller stone and duct size. By multivariate logistic regression, only duct dilation was associated with TS. Endoscopic success of complete duct clearance was achieved in 29 patients (80%). Endoscopic success was more frequent with stones 12 mm or less and with successful TS. By multivariate logistic regression, stones greater than 12 mm were associated with endoscopic failure.
CONCLUSIONS: Pre-SWL endotherapy does not affect stone fragmentation. Patients with a dilated duct (>8 mm) and pancreatic stones 12 mm or greater were associated with unsuccessful TS and endoscopic success, respectively, and may benefit from early referral for surgical decompression.
Pancreas. 2016 Mar 18. [Epub ahead of print]
Most urologists or operators of shockwave lithotripters have very limited experience of SWL of pancreatic stones. The present study was carried out to address the opposing recommendations by the European and American Societies of Gastrointestinal Endoscopy on whether patients with stones in the pancreatic duct should be offered an endoscopic procedure before or after SWL.
The results in 37 patients disclosed that successful SWL can be expected with stones stration of contrast medium usually through a naso-biliary catheter.