SWL literature
Slider

Tandan M. et al., 2019: ESWL for large pancreatic calculi: Report of over 5000 patients

Tandan M, Nageshwar Reddy D, Talukdar R, Vinod K, Kiran SVVS, Santosh D, Gupta R, Ramchandani M, Lakhtakia S, Rakesh K, Manohar Reddy P, Basha J, Nabi Z, Jagtap N, Rao GV.
Asian Institute of Gastroenterology, Hyderabad, India.
Asian Institute of Gastroenterology, Hyderabad, India.

Abstract 

INTRODUCTION: The primary aim of this study was to evaluate efficacy, safety and short-term pain relief after ESWL for large pancreatic calculi in over 5000 patients at a single center. METHODS: This is a retrospective analysis of prospectively collected data. Patients with painful calculi >5 mm, located in the head, neck and body region in the MPD, who were not amenable for extraction by the standard procedure of endoscopic pancreatic sphincterotomy were subjected to ESWL using a third generation dual focus lithotripter. Patients were followed up at 6 months for outcome evaluation. RESULTS: A total of 5124 patients (66% males) were subjected to ESWL. Majority of stones (79.2%) were radiopaque. Single calculi were seen in 3851 (75.1%).The majority of stones were located in head region of MPD in 2824 (55.1%) patients. 4386 (85.5%) patients required 3 or less sessions for fragmentation and complete stone clearance was achieved in 3722 (72.6%). EPS was performed in 5022 (98%) while PD stenting was required in 3536 (69%) patients. Of the 4280 patients followed up for 6 months, 3529 (82.6%) patients were pain free. Another 512 (11.9%) patients had significant reduction in VAS score. In 229 (5.3%) there was no decrease in pain intensity. Minor and self-limiting complications were reported in 1153 (22.5%). DISCUSSION: Our study confirms the safety and efficacy and short-term pain relief of ESWL for large calculi in the MPD. In properly selected patients, this should be offered as the first line of therapy for all large MPD calculi not amenable to the standard techniques of stone extraction.

Pancreatology. 2019 Oct;19(7):916-921. doi: 10.1016/j.pan.2019.08.001. Epub 2019 Aug 2.

 

 

0
 

Commentaires 1

Hans-Göran Tiselius le mercredi 4 décembre 2019 08:15

The authors report an impressive number of patients with pancreatic stones treated with SWL. A total of 5124 patients were treated during a period of approximately 15 years! That gives an annual number of around 340 patients and it obvious that the large number of treatments has given the authors an extraordinary experience.

Although SWL of pancreatic stones does not belong to the urological field, it is of note that the ESGE clinical guidelines recommend SWL followed by ERCP as first line standard approach for pancreatic stones. It is thus likely that urologists responsible for SWL service might be exposed to this clinical problem.

This is an Indian study and the aetiology of chronic pancreatitis with stone formation was usually non-alcoholic. The stone composition is not reported but it is stated that the stones, contrary to the reviewer’s experience, were hard and accordingly required repeated SWL sessions to be adequately disintegrated. One explanation for this result might have been the large size of the stones of which as many as 88% were treated more than once. More than 50% were treated with three sessions. The patients were given 5000-6000 sw at each session and although no long-term results are presented it is mentioned that 465 patients had a 12 year follow-up.

It would be highly interesting to see in a more complete long-term follow-up how the shock-waves have affected the pancreatic exocrine and endocrine functions.

Bottom-line: Knowledge of how to handle these patients is essential for those responsible for SWL in the region/hospital.

The authors report an impressive number of patients with pancreatic stones treated with SWL. A total of 5124 patients were treated during a period of approximately 15 years! That gives an annual number of around 340 patients and it obvious that the large number of treatments has given the authors an extraordinary experience. Although SWL of pancreatic stones does not belong to the urological field, it is of note that the ESGE clinical guidelines recommend SWL followed by ERCP as first line standard approach for pancreatic stones. It is thus likely that urologists responsible for SWL service might be exposed to this clinical problem. This is an Indian study and the aetiology of chronic pancreatitis with stone formation was usually non-alcoholic. The stone composition is not reported but it is stated that the stones, contrary to the reviewer’s experience, were hard and accordingly required repeated SWL sessions to be adequately disintegrated. One explanation for this result might have been the large size of the stones of which as many as 88% were treated more than once. More than 50% were treated with three sessions. The patients were given 5000-6000 sw at each session and although no long-term results are presented it is mentioned that 465 patients had a 12 year follow-up. It would be highly interesting to see in a more complete long-term follow-up how the shock-waves have affected the pancreatic exocrine and endocrine functions. Bottom-line: Knowledge of how to handle these patients is essential for those responsible for SWL in the region/hospital.
Invité
mercredi 26 février 2020
STORZ MEDICAL AG
Lohstampfestrasse 8
8274 Tägerwilen
Switzerland
Tel.: +41 (0)71 677 45 45
Fax: +41 (0)71 677 45 05

www.storzmedical.com