Yu Liu et al., 2024: Safety evaluation of extracorporeal shockwave lithotripsy for pancreatic stones: Experience based on a large chronic pancreatitis cohort
Yu Liu 1, Jin-Hui Yi 2, Peng-Yuan Wang 3, Peng Fu 4, Ying Kang 5, Teng Wang 2, Di Zhang 2, Xi-Hong Zhang 6, Jin-Jie Xu 2, Song-Lin Zhang 2, Pei-Dong Han 2, Fan Wang 2, Xiao-Yu Zhou 2, Jia-Sheng Feng 2, Jia-Jun Xu 2, Jia-Hao Qian 2, Dan Wang 2, Hui Chen 2, Run-Hui Liu 7, Fang-Yu Wang 8, Zhao-Shen Li 9, Liang-Hao Hu 10
1Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China; Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China; Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, 200433, China.
2Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China.
3Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China; Department of Gastroenterology, the 981st Hospital of PLA, Chengde, 067000, Hebei, China.
4Department of Pharmacy, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
5Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China.
6Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, 250012, Shandong, China; Department of Critical Care Medicine, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China.
7Department of Pharmacology, College of Pharmacy, Naval Medical University, Shanghai, 200433, China.
8Department of Gastroenterology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210000, Jiangsu, China.
9Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China.
10Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, 200433, China; Shanghai Institute of Pancreatic Diseases, Shanghai, 200433, China.
Abstract
Background: The safety of extracorporeal shock wave lithotripsy for pancreatic stones (P-ESWL) and adverse events were not evaluated and classified within large sample population. This study aimed to evaluate the safety and classify the adverse events of P-ESWL based on a large sample cohort.
Methods: This is an observational study based on the large prospective chronic pancreatitis (CP) cohort. Patients with painful pancreatic stones over 5 mm who underwent P-ESWL between March 2011 and June 2018 at Shanghai Changhai Hospital were included. Adverse events after P-ESWL including complications and transient adverse events (TAEs) were recorded. Risk factors of adverse events were analyzed through univariable and multivariable logistics regression analysis. Sensitivity analysis was conducted to test the stability of the study.
Results: Totally 2,071 patients underwent 5,002 sessions of P-ESWL were included. The overall complication rate and TAEs rate after all P-ESWL procedures were 5.2% and 20.9%. The complications and TAEs rate decreased obviously within the first 6 sessions. Several independent risk factors for adverse events after P-ESWL were identified. Sensitivity analysis suggested the stability of the results.
Conclusions: P-ESWL is a safe treatment for pancreatic stones. Multiple P-ESWL sessions did not increase the complications and TAEs rate. ClincialTrials.gov number, NCT05916547.
Dig Liver Dis. 2024 Sep 10:S1590-8658(24)00962-9. doi: 10.1016/j.dld.2024.08.043. Online ahead of print. PMID: 39261265
Comments 1
It is interesting to note that whereas SWL initially was an exceptional method for treatment of pancreatic stones, the procedure now is recommended for stones >5 mm (if stones are in the head or body. For smaller stones (rizes the occurrence of complications in a huge number of treatments. The report is based on data collected from 2071 patients treated with 5002 SWL-sessions. This must be a unique material in which the authors discriminate between complications (C) and transient adverse events (TAE) The overall result showed that C was recorded in only 262 patients (5.2%) and TAE in 20.9%. For those operators who carry out SWL of pancreatic stones, this article is valuable reading!
One important observation was that 26.4% of the patients had asymptomatic hyperamylasemia after the first SWL session, but in only 17.1% of patients after repeated sessions.
Pancreatitis, infection, bleeding, perforation and steinstrasse were the most recorded complications.
Although the occurrences of C and TAE are relatively few, and less common than expected it is important to be observant on any side effects that might follow SWL of pancreatic stones.
Interestingly the overall number of SWL sessions was 2.4.
Hans-Göran Tiselius