Liu Y. et al., 2026: Nutritional recovery after minimally invasive pancreatic stone treatment: Body mass index dynamics and predictors in chronic pancreatitis cohorts.

Liu Y, Feng XY, Chen C, Wang T, Yi JH, Zhang SL, Han PD, Wang D, Wang FY, Li ZS, Hu LH.
Dig Liver Dis. 2026 Jul;58(7):943-956. doi: 10.1016/j.dld.2026.03.020

Abstract

Background and aim: This study assessed post-intervention body mass index (BMI) changes and associated risk factors in chronic pancreatitis (CP) patients undergoing minimally invasive treatment for pancreatic stones.

Methods: This retrospective-prospective cohort study enrolled adult CP patients with painful pancreatic stones (>5 mm) who underwent combined pancreatic extracorporeal shock wave lithotripsy (P-ESWL) followed by endoscopic retrograde cholangiopancreatography between March 2011 and June 2018. Patients were prospectively followed until March 2024. BMI was assessed pre-intervention and at final follow-up. Logistic regression identified independent predictors of post-procedural BMI changes.

Results: Among 1978 patients undergoing P-ESWL, 1562 (79.0 %) with ≥ 1-year follow-up were analyzed. Baseline BMI distribution showed 65.1 % (n = 1017) normal weight (18.5-24.0 kg/m²), 16.9 % (n = 264) overweight/obese (≥24.0 kg/m²), and 18.0 % (n = 281) underweight (<18.5 kg/m²). Post-procedural complication rates were similar across BMI subgroups. During follow-up, 66.8 % (n = 1044) maintained normal BMI, while 33.2 % (n = 518) experienced post-treatment BMI outside the normal range-12.0 % became underweight and 21.2 % overweight/obese. Five independent predictors of post-treatment BMI outside the normal range were identified: baseline BMI status, frequent acute pancreatitis attacks (>1/year), prior severe acute pancreatitis, multiple stones, and CP-related treatment during follow-up.

Conclusions: Minimally invasive pancreatic stone treatment causes significant BMI changes with identifiable predictors. Integrating metabolic risk stratification into CP management algorithms could optimize long-term outcomes.

Comment Peter Alken

Very extensive, detailed study. However, I would not agree with the authors that ESWL of pancreatic stone itself causes significant BMI changes. Probably more important is “The findings introduce the critical need for metabolic risk stratification in CP management, suggesting that long-term nutritional and metabolic monitoring should be integrated into standard follow-up care algorithms to optimize outcomes beyond pain relief.”

Peter Alken