Yi JH. et al., 2023: Adverse events of pancreatic extracorporeal shock wave lithotripsy: a literature review.

Tuesday, 07 May 2024

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Yi JH, Li ZS, Hu LH.
Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.
Department of Gastroenterology, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, China.

Abstract

Pancreatic stones are the result of pathophysiologic changes in chronic pancreatitis with an incidence of more than 90%. At present, pancreatic extracorporeal shock wave lithotripsy (P-ESWL) can be used as the first-line treatment for large or complex stones. Although a large number of studies have proven the safety and effectiveness of P-ESWL, we should also pay attention to postoperative adverse events, mainly due to the scattering of shock waves in the conduction pathway. Adverse events can be classified as either complications or transient adverse events according to the severity. Because the anatomic location of organs along the shock wave conducting pathway differs greatly, adverse events after P-ESWL are varied and difficult to predict. This paper outlines the mechanism, definition, classification, management and risk factors for adverse events related to P-ESWL. It also discusses the technique of P-ESWL, indications and contraindications of P-ESWL, and adverse events in special populations.

BMC Gastroenterol. 2023 Oct 18;23(1):360. doi: 10.1186/s12876-023-02992-0. PMID: 37853330 Review. FREE PMC ARTICLE

Comments 1

Hans-Göran Tiselius on Tuesday, 07 May 2024 11:00

Pancreatic stones are not a urological diagnosis, but as responsible for lithotripters, urologists are commonly asked to carry out ESWL of pancreatic stones (P-ESWL).

This review article summarizes all common as well as rare complications and provides useful reading for all those who might be involved in this kind of treatment.

First it is important to consider how P-ESWL best should be carried out and it is mentioned that patients usually are placed in supine position with the therapy-head above the table to administer shock waves transabdominally. Some lithotripters do not have this facility and therefore P-ESWL needs to be completed with the patient in prone position! My own reflection is that with the latter position patient movement and respiratory movements might be decreased compared with the case in supine position.

The authors state that treatment usually should be carried out with general or epidural anesthesia, but in my own experience treatment with analgesics and sedatives (alfentanyl and propofol given by specially educated nurses) works well and is easier to perform because anesthesia service is unnecessary.

One point that deserves a comment is the statement that treatment of pancreas stones requires higher shock wave energy. This statement is not necessarily true because several pancreatic stones are composed of calcium carbonate. Such stones are brittle and surprisingly easy to disintegrate. Stepwise increment of sw-energy (ramping) might give necessary information in this regard.
The authors discriminate between complications and transient adverse effects (TAEs).
Among TAEs, asymptomatic hyperamylasemia, hematuria and mucosa injuries are most common. It is important to measure S/P-amylase before and after P-ESWL to exclude acute pancreatitis. That pancreatitis is the most common complication is not surprising and it is of note that administration of NSAID can be protective.

Inasmuch as various complications can be seen it is important, when symptoms occur, always to carry out a CT-examination to exclude or identify injuries to the pancreas as well as to extra-pancreatic organs.

The important message is that P-ESWL should be the first-line therapy for patients with stones in the main pancreatic duct. Urologists engaged in this kind of treatment are strongly recommended to read this article.

Hans-Göran Tiselius

Top publication

Pancreatic stones are not a urological diagnosis, but as responsible for lithotripters, urologists are commonly asked to carry out ESWL of pancreatic stones (P-ESWL).

This review article summarizes all common as well as rare complications and provides useful reading for all those who might be involved in this kind of treatment.

First it is important to consider how P-ESWL best should be carried out and it is mentioned that patients usually are placed in supine position with the therapy-head above the table to administer shock waves transabdominally. Some lithotripters do not have this facility and therefore P-ESWL needs to be completed with the patient in prone position! My own reflection is that with the latter position patient movement and respiratory movements might be decreased compared with the case in supine position.

The authors state that treatment usually should be carried out with general or epidural anesthesia, but in my own experience treatment with analgesics and sedatives (alfentanyl and propofol given by specially educated nurses) works well and is easier to perform because anesthesia service is unnecessary.

One point that deserves a comment is the statement that treatment of pancreas stones requires higher shock wave energy. This statement is not necessarily true because several pancreatic stones are composed of calcium carbonate. Such stones are brittle and surprisingly easy to disintegrate. Stepwise increment of sw-energy (ramping) might give necessary information in this regard.
The authors discriminate between complications and transient adverse effects (TAEs).
Among TAEs, asymptomatic hyperamylasemia, hematuria and mucosa injuries are most common. It is important to measure S/P-amylase before and after P-ESWL to exclude acute pancreatitis. That pancreatitis is the most common complication is not surprising and it is of note that administration of NSAID can be protective.

Inasmuch as various complications can be seen it is important, when symptoms occur, always to carry out a CT-examination to exclude or identify injuries to the pancreas as well as to extra-pancreatic organs.

The important message is that P-ESWL should be the first-line therapy for patients with stones in the main pancreatic duct. Urologists engaged in this kind of treatment are strongly recommended to read this article.

Hans-Göran Tiselius

Top publication

Pancreatic stones are not a urological diagnosis, but as responsible for lithotripters, urologists are commonly asked to carry out ESWL of pancreatic stones (P-ESWL). This review article summarizes all common as well as rare complications and provides useful reading for all those who might be involved in this kind of treatment. First it is important to consider how P-ESWL best should be carried out and it is mentioned that patients usually are placed in supine position with the therapy-head above the table to administer shock waves transabdominally. Some lithotripters do not have this facility and therefore P-ESWL needs to be completed with the patient in prone position! My own reflection is that with the latter position patient movement and respiratory movements might be decreased compared with the case in supine position. The authors state that treatment usually should be carried out with general or epidural anesthesia, but in my own experience treatment with analgesics and sedatives (alfentanyl and propofol given by specially educated nurses) works well and is easier to perform because anesthesia service is unnecessary. One point that deserves a comment is the statement that treatment of pancreas stones requires higher shock wave energy. This statement is not necessarily true because several pancreatic stones are composed of calcium carbonate. Such stones are brittle and surprisingly easy to disintegrate. Stepwise increment of sw-energy (ramping) might give necessary information in this regard. The authors discriminate between complications and transient adverse effects (TAEs). Among TAEs, asymptomatic hyperamylasemia, hematuria and mucosa injuries are most common. It is important to measure S/P-amylase before and after P-ESWL to exclude acute pancreatitis. That pancreatitis is the most common complication is not surprising and it is of note that administration of NSAID can be protective. Inasmuch as various complications can be seen it is important, when symptoms occur, always to carry out a CT-examination to exclude or identify injuries to the pancreas as well as to extra-pancreatic organs. The important message is that P-ESWL should be the first-line therapy for patients with stones in the main pancreatic duct. Urologists engaged in this kind of treatment are strongly recommended to read this article. Hans-Göran Tiselius Top publication

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