Moole H et al, 2015: A Meta-Analysis and Systematic Review: Success of Extracorporeal Shock Wave Lithotripsy in Chronic Calcific Pancreatitis Management.
Moole H, Jaeger A, Bechtold ML, Forcione D, Taneja D, Puli SR.
Division of General Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL; †Division of Gastroenterology and Hepatology, University of Missouri-Columbia, Columbia, MO; ‡Interventional Endoscopy Services, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA; §Division of Pulmonary Medicine, Department of Medicine, Saint Francis Medical Center, Peoria, IL; and ∥Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL.
Abstract:
OBJECTIVES: This is a meta-analysis and systematic review to assess the overall utility and safety of Extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis. Primary outcomes are pain relief, narcotic usage, ductal clearance, quality of life, and pancreatic exocrine and endocrine function.
METHODS: Studies involving ESWL in chronic calcific pancreatitis with main pancreatic duct stones greater than 5 mm and patients that failed conservative pain management were included. Fixed and random effects models were used to calculate the pooled proportions.
RESULTS: Initial search identified 1471 reference articles, in which 184 articles were selected and reviewed. Data were extracted from 27 studies (N = 3189) which met the inclusion criterion. The pooled proportion of patients with absence of pain at follow-up was 52.7% (95% confidence interval [95% CI], 50.85-54.56) and mild to moderate pain at follow-up was 33.43% (95% CI, 31.40-35.50). Quality of life improved in 88.21% (95% CI, 85.43-90.73) and complete ductal clearance was 70.69% (95% CI, 68.97-72.38) in the pooled patients.
CONCLUSIONS: The ESWL is an effective and safe management option in patients with chronic calcific pancreatitis patients with main pancreatic duct stone size greater than 5 mm who did not get adequate pain relief with conservative management.
Pancreas. 2015 Nov 17. [Epub ahead of print]
Comments 1
Although treatment of pancreatic duct stones in patients with chronic calcific pancreatitis is not a urological concern, such patients are occasionally referred to operators of SWL machines for assistance.
It is therefore of interest to learn from this meta-analysis that SWL can be a useful and important tool for elimination of stones in the pancreatic duct. Unfortunately the authors were not able to tell which role SWL might play as isolated treatment modality, because in the summarized reports most patients seem to have undergone a combined treatment with SWL and endoscopy. This lack of information is unfortunate inasmuch as calcium carbonate, a common constituent of pancreatic stones, usually is very easy to disintegrate.
The clinical problem with this group of patients is usually related to difficulties to localise the stones and to find the most appropriate patient positioning for the treatment.