Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE trial): study protocol for a randomized, sham-controlled trial

Olesen, Søren Schou; Drewes, Asbjørn Mohr; Gaud, Rajesh; Tandan, Manu; Lakhtakia, Sundeep; Ramchandani, Mohan; Rao, Guduru Venkat; Reddy, D. Nageshwar; Talukdar, Rupjyoti

doi:10.1186/s13063-020-04296-0

Cited by 14 publications

(16 citation statements)

References 43 publications

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“…As a non-invasive physical stimulus, extracorporeal shock wave therapy has been widely used in clinical fields such as osteoarthritis ( 39 ), chronic pancreatitis ( 40 ), and renal calculus ( 41 ). In recent years, it has been found that ECSW can also promote angiogenesis, which not only provides a new idea for the treatment of CHD, but also provides a new choice for adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Wang

Yang

et al. 2021

Front. Cardiovasc. Med.

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Background: Extracorporeal cardiac shock waves (ECSW) have great potential in the treatment of coronary heart disease. Endothelial progenitor cells (EPCs) are a class of pluripotent progenitor cells derived from bone marrow or peripheral blood, which have the capacity to migrate to ischemic myocardium and differentiate into mature endothelial cells and play an important role in neovascularization and endothelial repair. In this study, we investigated whether ECSW therapy can improve EPCs dysfunction and apoptosis induced by hypoxia and explored the underlying mechanisms.Methods: EPCs were separated from ApoE gene knockout rat bone marrow and identified using flow cytometry and fluorescence staining. EPCs were used to produce in vitro hypoxia-injury models which were then divided into six groups: Control, Hypoxia, Hypoxia + ECSW, Hypoxia + LY294002 + ECSW, Hypoxia + MK-2206 + ECSW, and Hypoxia + L-NAME + ECSW. EPCs from the Control, Hypoxia, and Hypoxia + ECSW groups were used in mRNA sequencing reactions. mRNA and protein expression levels were analyzed using qRT-PCR and western blot analysis, respectively. Proliferation, apoptosis, adhesion, migration, and angiogenesis were measured using CCK-8, flow cytometry, gelatin, transwell, and tube formation, respectively. Nitric oxide (NO) levels were measured using an NO assay kit.Results: Kyoto encyclopedia of genes and genomes (KEGG) enrichment analysis showed that differentially expressed genes were enriched in cancer signaling, PI3K-Akt signaling, and Rap1 signaling pathways. We selected differentially expressed genes in the PI3K-Akt signaling pathway and verified them using a series of experiments. The results showed that ECSW therapy (500 shots at 0.09 mJ/mm2) significantly improved proliferation, adhesion, migration, and tube formation abilities of EPCs following hypoxic injury, accompanied by upregulation of p-PI3K, p-Akt, p-eNOS, Bcl-2 protein and NO, PI3K, and Akt mRNA expression, and downregulation of Bax and Caspase3 protein expression. All these effects of ECSW were eliminated using inhibitors specific to PI3K (LY294002), Akt (MK-2206), and eNOS (L-NAME).Conclusion: ECSW exerted a strong repaired effect on EPCs suffering inhibited hypoxia injury by inhibiting cell apoptosis and promoting angiogenesis, mainly through activating the PI3K/Akt/eNOS signaling pathway, which provide new evidence for ECSW therapy in CHD.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Wang

Yang

et al. 2021

Front. Cardiovasc. Med.

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“…The reference population here consisted of 382 (44%) patients who completed the EORTC QLQ‐C30 questionnaire a median of two 1–39 years after their diagnosis. The two groups did not differ in age, sex, alcohol or by aetiology but the reference population had a shorter disease duration ( p < 0.001) and more smoking ( p = 0.029).…”

Section: Resultsmentioning

confidence: 99%

“…There was no difference in pain response among patients needing multiple pancreatic stents compared to patients who had one pancreatic stent, which is reassuring as most patients needed multiple procedures. It should be noted, however, that any intervention will have a major effect on pain, and this is being explored in an ongoing study comparing EP + ESWL with sham interventions 37,38 …”

Section: Discussionmentioning

confidence: 99%

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study

Parhiala,

Nøjgaard,

Bartholdy

et al. 2023

UEG Journal

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BackgroundChronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions.ObjectiveOur aim was to determine the frequency of endoscopic procedures (EP) in CP patients and to analyse pain and quality of life (QoL) in these patients after their EP.MethodsThis study included 1327 CP patients from the Scandinavian Baltic Pancreatic Club (SBPC) database including four countries and eight centres. We analysed patients undergoing EPs and gathered information on the EP, pancreatic function, pain, disease and duration. The EORTC C‐30 QoL questionnaire was gathered prospectively and multivariable analysis was conducted on independent parameters between the groups. The reference population had no interventions (n = 870).Results260 CP patients (22%) underwent EPs, median one year (range 0–39 years) after CP diagnosis. 68% were males. The median age was 59 (20–90) years. Most common aetiological factors were alcohol in 65% and smoking in 71%. Extracorporeal shock wave lithotripsy (ESWL) was used in 6% of the CP population and in 21% of the EP group. Biliary duct stenting was performed on 37% and pancreatic stenting was performed on 56% of the patients. There was no difference in pain patterns between patients who had pancreatic stenting and the reference population. The EP group had slightly better QoL (p = 0.047), functioning and fewer symptoms than the reference population, in the multivariable analysis there was no interaction effect analysis between the groups. The pancreatic stent group had better QoL and the same amount of pain than the reference group. The patients who needed later surgery (23%) had more pain (p = 0.043) and fatigue (p = 0.021).ConclusionsOne in five of the CP patients underwent EP. These patients scored higher on QoL responses and had better symptom scores. CP patients who had pancreatic stenting performed had the same pain patterns as the reference population. Randomised prospective trials are needed to determine the effect of endoscopy procedures on CP patients.

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“…Pancreatic duct obstruction is the primary indication for endoscopic and/or surgical therapy in patients with CP according to recent guidelines ( 3 , 14 ). However, the pain-relieving effect of pancreatic duct decompression is debated and currently under evaluation in a sham-controlled trial ( 39 , 40 ). The effect of pancreatic duct decompression on pancreatic functional parameters and morphology is difficult to comprehend because this requires long-term follow-up (for several years), which will hardly be feasible in a sham-controlled study ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Course of Medically Managed Patients With Large and Small Duct Chronic Pancreatitis

Mahdi

Steinkohl

Singh

et al. 2022

Clin Transl Gastroenterol

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INTRODUCTION: Pancreatic duct obstruction is the primary indication for endoscopic and/or surgical therapy in patients with chronic pancreatitis (CP). However, the clinical course of medically managed patients in relation to pancreatic duct obstruction is largely unknown. METHODS: This was a retrospective cohort study of medically managed patients with CP. We classified patients based on pancreatic duct obstruction from a stricture or stone using cross-sectional imaging (i.e., large vs small duct CP). We compared prevalence of diabetes and exocrine insufficiency (EPI) between subgroups at inclusion and investigated risk of new-onset diabetes, EPI, and all-cause mortality over a follow-up period of 5 years. Changes in pancreatic morphology were studied in patients who underwent follow-up imaging. RESULTS: A total of 198 patients (mean age 58 ± 12 years, 70% male, 60% alcoholic etiology, 38% large duct CP) were evaluated. At inclusion, patients with large vs small duct CP had a higher prevalence of both diabetes (43% vs 24%, P = 0.004) and EPI (47% vs 28%, P = 0.007). There was an increased risk of new-onset EPI in patients with large duct CP (hazard ratio 1.72; 95% confidence interval [1.05–2.80], P = 0.031) and higher rates of pancreatic atrophy ( P < 0.001). No differences between groups were observed for new-onset diabetes and all-cause mortality. Conversion from small to large duct CP or vice versa during follow-up was observed in 14% of patients. DISCUSSION: In a medically managed cohort of patients, large duct CP was associated with increased risk of EPI and pancreatic atrophy compared with small duct CP.

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Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE trial): study protocol for a randomized, sham-controlled trial

Cited by 14 publications

References 43 publications

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Extracorporeal Cardiac Shock Waves Therapy Improves the Function of Endothelial Progenitor Cells After Hypoxia Injury via Activating PI3K/Akt/eNOS Signal Pathway

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study

Clinical Course of Medically Managed Patients With Large and Small Duct Chronic Pancreatitis

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