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Yamamoto s. et al., 2024: A Predictive Strategy for Nonsurgical Management of Pancreatic Stones.

Yamamoto S, Inui K, Katano Y, Miyoshi H, Kobayashi T, Tachi Y.
From the Department of Gastroenterology, Fujita Health University Bantane Hospital, Nagoya.
Department of Gastroenterology, Yamashita Hospital, Ichinomiya.
Department of Gastroenterology, Fujita Health University Okazaki Medical Center, Okazaki, Japan.

Abstract

Objectives: We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient.

Materials and methods: We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis.

Results: Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones.

Conclusions: If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.

Pancreas. 2024 Feb 12. doi: 10.1097/MPA.0000000000002310. Online ahead of print.
PMID: 38345918

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Comments 1

Hans-Göran Tiselius on Tuesday, 04 June 2024 11:00

It is of interest to learn that SWL is the first line treatment of stones in the pancreatic duct. In the current report from Japan the data of 165 patients were examined retrospectively.
Interestingly, 57 of 63 patients (90%) who only were treated with SWL became stone-free. In the remaining 101 patients, endoscopic procedures were added, while 12 patients underwent surgery.
It is of note that during a period of 28 years, up to 2020, all patients were treated with the electrohydraulic Direx Tripter X-1 lithotripter. There is, unfortunately, no details on patient positioning, type of anesthesia or administration of analgesics. Neither is there any information on any problems with the shockwave path. All such data had indeed been of interest, given that the authors obviously allowed a large number of SWL sessions.
Two factors were most important for stone clearance: size

It is of interest to learn that SWL is the first line treatment of stones in the pancreatic duct. In the current report from Japan the data of 165 patients were examined retrospectively. Interestingly, 57 of 63 patients (90%) who only were treated with SWL became stone-free. In the remaining 101 patients, endoscopic procedures were added, while 12 patients underwent surgery. It is of note that during a period of 28 years, up to 2020, all patients were treated with the electrohydraulic Direx Tripter X-1 lithotripter. There is, unfortunately, no details on patient positioning, type of anesthesia or administration of analgesics. Neither is there any information on any problems with the shockwave path. All such data had indeed been of interest, given that the authors obviously allowed a large number of SWL sessions. Two factors were most important for stone clearance: size
Saturday, 13 July 2024