Wang D et al, 2017: Extracorporeal shock wave lithotripsy is safe and effective for pediatric patients with chronic pancreatitis.
Wang D, Bi YW, Ji JT, Xin L, Pan J, Liao Z, Du TT, Lin JH, Zhang D, Zeng XP, Ye B, Zou WB, Chen H, Xie T, Li BR, Zheng ZH, Li ZS, Hu LH.
Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China.
Department of Surgery, Jinling Hospital, Nanjing, China.
Digestive Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China.
Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China.
Department of Gastroenterology, Air Force General Hospital, Beijing, China.
Department of Traditional Chinese Medicine, Jiangdu Hospital, Yangzhou, China.
Background and aims: Pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is recommended as the first-line treatment for pancreatic stones. However, how well P-ESWL performs in pediatric patients remains unclear. We aimed to evaluate the safety and efficacy of P-ESWL for pediatric patients with chronic pancreatitis.
Methods: This prospective observational study was conducted in patients with painful chronic pancreatitis who underwent P-ESWL. Patients aged under 18 years were included in the pediatric group; patients aged over 18 years who underwent P-ESWL in the same period were assigned to the control group. For investigation of long-term follow-up, the pediatric group were matched with patients from the control group in a 1:1 ratio. The primary outcomes were P-ESWL complications and pain relief. The secondary outcomes included: stone clearance, physical and mental health, quality of life score, and growth and developmental state.
Results: From March 2011 to March 2015, P-ESWL was performed in 1135 patients (72 in the pediatric group, 1063 in the control group). No significant differences were observed in the occurrence of P-ESWL complications between the two groups (11.1 % vs. 12.8 %; P = 0.68). Among the 67 pediatric patients (93.1 %) who underwent follow-up for 3.0 years (range 1.3 - 5.2), complete pain relief was achieved in 52 patients (52 /67; 77.6 %); this value was not significantly different from that of the matched controls (55 /69; 79.7 %; P = 0.94).
Conclusions: P-ESWL is safe and effective for pediatric patients with chronic pancreatitis. It can promote significant pain relief and stone clearance, and can benefit growth and development.
Endoscopy. 2017 May;49(5):447-455. doi: 10.1055/s-0043-104527. Epub 2017 Apr 12. FREE ARTICLE
This is a report on the safety and efficacy of ESWL done in intravenous sedation analgesia in a rare disease. It is interesting to read the details of this well done study, to see the differences of gastroenterological and urological treatment and to think how each faculty could learn from the other how to handle a stone problem: “The incidence of chronic pancreatitis in children is approximately 0.5 per 100 000 per year. … Pancreatic stones are present in … 12%– 69.7% of pediatric patients with chronic pancreatitis.” While “Treatment of pancreatic stones in adults is standardized, with guidelines available … a consensus regarding the treatment strategy for pediatric patients with chronic pancreatitis is not available.” In this series “The age of the pediatric patients who underwent P-ESWL was 15.2 ± 2.2 years (range 8.0 – 18.0 years).”
“For each individual patient, the P-ESWL session was repeated on consecutive days until the stone was fragmented to ≤ 3 mm in diameter. No more than 5000 shocks at an intensity of 6 (16 000 kV) on a scale of 1 – 6, at a frequency of 120 shocks/min were delivered during each therapeutic session. The duration of each session was 60– 90 minutes. Endoscopic retrograde cholangiopancreatography (ERCP) was routinely performed 48 hours after the last P-ESWL“
“During the ERCP performed post-ESWL, complete clearance of the stones was achieved in 86.1% of the patients in the pediatric group (62 /72) and 94.4% in the matched controls (68 /72; P = 0.07).” “In the pediatric group, eight complications of P-ESWL occurred in eight patients (8 /72; 11.1%), with five of these patients presenting with mild post-ESWL pancreatitis (PEP), two presenting with moderate PEP, and one presenting with mild steinstrasse.”
Among the secondary outcomes of this study the statistically significant reduction of the mean number of days absent from school from 40.0(4.0 – 334.0) to 0.0 (0.0 – 120.0) days is even more impressive than the pain reduction.
Because of the quality of the study on this “orphan disease” this is my second reviewer’s choice and the first one on a gastroenterological publication