Yamamoto S. et al., 2022: Pancreatic Stones: clinical outcomes with nonsurgical treatment in a Japanese single-center study.
Yamamoto S, Inui K, Katano Y, Miyoshi H, Kobayashi T, Tachi Y, Torii Y.
Department of Gastroenterology, Yamashita Hospital, Ichinomiya.
From the Department of Gastroenterology, Fujita Health University Bantane Hospital, Nagoya, Japan.
Department of Gastroenterology, Fujita Health University Okazaki Medical Center, Okazaki, Japan.
Objectives: While chronic pancreatitis associated with pancreatolithiasis presents with pain, exocrine and endocrine pancreatic functions worsen with time. We examined outcomes of nonsurgical treatment.
Methods: Between 1992 and 2020, we treated pancreatolithiasis nonsurgically in 165 patients with chronic pancreatitis using extracorporeal shock wave lithotripsy alone or followed by endoscopic procedures. The mean follow-up duration was 49 months (standard deviation, 56 months) and the age was 56 years (standard deviation, 13 years). The male:female ratio was 5.1:1 (138 men, 27 women). We followed treatment results including relief of abdominal pain, stone clearance and recurrence, and pancreatic exocrine function (bentiromide-p-aminobenzoic acid testing).
Results: Treatment relieved pain in 117 of 124 patients (94%). The overall stone clearance was achieved in 130 of 165 patients (79%). Stones recurred during follow-up in 50 of 130 patients (38%). One fifth of recurrences were early, often involving stricture of the main pancreatic duct. After 1 year, 65% of the patients had improved or stable exocrine function.
Conclusions: Nonsurgical stone removal usually improved symptoms and preserved pancreatic exocrine function. Nonsurgical treatment with extracorporeal shock wave lithotripsy followed by endoscopic treatment if needed is useful as initial management for pancreatolithiasis.
Pancreas. 2022 Feb 1;51(2):205-211. doi: 10.1097/MPA.0000000000001996. PMID: 35404899
This article summarizes the Japanese experience of SWL in patients with pancreatic stones. Briefly, 94 % of the treated patients had pain relief and in as many as 79% stone clearance was recorded. It is of note that 65% of the patients had stable or improved exocrine pancreatic function lone year after SWL.
All patients in this series had been treated with SWL, but it is of note that some patients also required endoscopy. The details of SWL are not given.
This article might be of particular interest for those colleagues who regularly see patients with chronic pancreatitis and pancreatic stones.