Ru N. et al., 2021: Post-ESWL and post-ERCP pancreatitis in patients with chronic pancreatitis: Do they share the same risks?
Ru N, Qian YY, Zhu JH, Chen H, Zou WB, Hu LH, Pan J, Guo JY, Li ZS, Liao Z.J.
Department of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Shanghai, China.
National Clinical Research Center for Digestive Diseases, Shanghai, China.
Shanghai Institute of Pancreatic Diseases, Shanghai, China.
Abstract
Background: Endoscopic intervention combined with extracorporeal shock wave lithotripsy (ESWL) is recommended as the first line therapy for large pancreatic stones, yet both can cause adverse events. The aim of the study was to identify the risk factors for post-procedural pancreatitis.
Methods: Consecutive patients with chronic pancreatitis and pancreatic stones treated with both ESWL and subsequent endoscopic retrograde cholangiopancreatography (ERCP) from October 2016 to December 2019 were prospectively enrolled. Multivariate logistic analyses were performed to detect risk factors for post-ESWL and post-ERCP pancreatitis (PEP).
Results: A total of 714 patients (507 males, 45.60 ± 12.52 years) were included in this study. A total of 80 patients (11.2%) developed post-ESWL pancreatitis,while 33 patients (4.6%) suffered from PEP. Steatorrhea (P = .018), multiple stones (P = .043), and stones located at the head combined with the body or tail of the pancreas (P = .015) were identified as independent protective factors for post-ESWL pancreatitis. The history of acute exacerbations (P = .013), post-ESWL pancreatitis (P < .001) and stricture dilation during ERCP (P = .002) were identified as risk factors for PEP.
Conclusions: More attention should be paid to patients with post-ESWL pancreatitis, as well as a history of acute exacerbations and stricture dilation during ERCP to prevent PEP. (ClincialTrials.gov number, NCT04619511).
J Hepatobiliary Pancreat Sci. 2021 Sep;28(9):778-787. doi: 10.1002/jhbp.1013. Epub 2021 Jul 22. PMID: 34242478
Comments 1
Both SWL and ERCP are tools used by gastroenterologists to disintegrate stones in the pancreatic duct, encountered in patients with chronic pancreatitis. Although these treatments commonly are taken care of by gastroenterologists, it might be of interest also for the urologists responsible for SWL, to know about related problems when asked to assist in SWL. It is important to know, however, that both SWL and ERCP also might cause acute pancreatitis
In this study on 740 patients with chronic pancreatitis, post-SWL pancreatitis was observed in 6% and post-ERCP pancreatitis in 4.6%.
It is of note that SWL was carried out in supine position with up to 5000 sw at 16 kV (hopefully not 16 000 kV as stated). It is not mentioned if all stones easily could be placed in focus with this patient positioning.
The lesson learnt from this report is that attention must be paid to the risk of acute pancreatitis seen after SWL. The criteria for acute pancreatitis are pain and three-fold increase in amylase or lipase.
Hans-Göran Tiselius