Efficacy of Stone Density on Noncontrast Computed Tomography in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Patients With Pancreatic Stones

Ohyama, Hiroshi; Mikata, Rintaro; Ishihara, Takeshi; Tsuyuguchi, Toshio; Sakai, Yuji; Sugiyama, Harutoshi; Yasui, Shin; Ishii, Kiyofumi; Itoh, Sadahiro; Nishikawa, Takao; Watanabe, Yuto; Yokosuka, Osamu

doi:10.1097/mpa.0000000000000277

Cited by 39 publications

(37 citation statements)

References 26 publications

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“…If these calculi could be identified prior to subjecting them to ESWL then an alternative procedure can be advised. In a recent study Ohyama et al 42. have shown that calculi with density of >820.5 Hounsfield units on noncontrast computed tomography were associated with reduced stone fragmentation and clearance.…”

Section: Modalities Of Treatmentmentioning

confidence: 98%

Management of Pancreatic Calculi: An Update

2016

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Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy.

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Section: Modalities Of Treatmentmentioning

confidence: 98%

Management of Pancreatic Calculi: An Update

2016

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“…The 3-point Likert-Scale was used in three studies to define pain intensity [14,19,20]. The 4-grade Pain-Scale was used in two studies as a measure of pain intensity [21,22]. One of the authors [23] used the 5-point Likert-Scale to define pain intensity.…”

Section: Pain Reliefmentioning

confidence: 99%

Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis

et al. 2020

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Background and study aims Pain is the most frequent and dominant symptom of chronic pancreatitis. Currently, these patients are treated using a step-up approach, including analgesics and lifestyle adjustments, endoscopic, and eventually surgical treatment. Extracorporeal shock wave lithotripsy (ESWL) is indicated after failure of the first step in patients with symptomatic intraductal stones larger than 5 mm in the head or body of the pancreas. To assess the complete ductal clearance rate and pain relief after ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones, a systematic review and meta-analysis was performed. Patients and methods A systematic literature search from January 2000 to December 2018 was performed in PubMed, the Cochrane Library, and EMBASE for studies on ductal clearance rate of ESWL in patients with symptomatic chronic pancreatitis with pancreatic duct stones. Results After screening 486 studies, 22 studies with 3868 patients with chronic pancreatitis undergoing ESWL for pancreatic duct stones were included. The pooled proportion of patients with complete ductal clearance was 69.8 % (95 % CI 63.8–75.5). The pooled proportion of complete absence of pain during follow-up was 64.2 % (95 % CI 57.5–70.6). Complete stone fragmentation was 86.3 % (95 % CI 76.0–94.0). Post-procedural pancreatitis and cholangitis occurred in 4.0 % (95 % CI 2.5–5.8) and 0.5 % (95 % CI 0.2–0.9), respectively. Conclusion Treatment with ESWL results in complete ductal clearance rate in a majority of patients, resulting in absence of pain during follow up in over half of patients with symptomatic chronic pancreatitis caused by obstructing pancreatic duct stones.

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“…anesthesia is needed and, particularly with more than one stone in different parts of the MPD, multiple sessions are required to facilitate effective fragmentation and MPD clearance. In addition, calculi with a density of >820.5 Hounsfield units seem to respond less effectively to ESWL . As standard of practice, different interventions are needed for MPD clearance (ERCP, ESWL), which leads to additional procedures and costs.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? Systematic review

Beyna

Neuhaus

Gerges

2017

Digestive Endoscopy

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Background and Aim: The main treatment aim in chronic pancreatitis (CP) is symptom control and especially pain relief. Management of stone-predominant CP is challenging and requires a multidisciplinary approach. Extracorporeal shock wave lithotripsy (ESWL) has emerged as the cornerstone of nonsurgical treatment as a result of disappointing results of available endoscopic treatment options during the last decades. With new developments in the field of direct peroral pancreatoscopy (POP) and intracorporeal lithotripsy, direct intraluminal treatment of main pancreatic duct (MPD) stones returns to the spotlight.Methods: Herein, we reviewed the current data on direct pancreatoscopic treatment of MPD stones with a focus on efficiency and safety of available technologies, endoscopes and lithotripsy devices. A systematic Medline search for relevant studies was done.Results: Ten relevant publications meeting the inclusion criteria were identified (two prospective series, six retrospective trials, two case reports, n = 87 patients). Successful ductal clearance for POP-guided treatment was reported as between 43% and 100% compared to ESWL with 59% to 80%. Adverse event rate for POP-guided therapy was reported as 0-13.5%. One study showed a noticeable higher adverse event rate of 43%. In this trial, POP was carried out after ESWL. There is no reported mortality following POP treatment. Conclusion:Available results are promising in terms of ductal clearance and pain relief compared to standard endoscopic techniques and ESWL as the current gold standard for lithotripsy. Interpretation of this data is limited by the small number of cases for POP and the lack of prospective randomized controlled trials.

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Efficacy of Stone Density on Noncontrast Computed Tomography in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Patients With Pancreatic Stones

Abstract: The measurement of pancreatic stone density before therapy can help predict therapeutic outcomes.

Cited by 39 publications

References 26 publications

Management of Pancreatic Calculi: An Update

Management of Pancreatic Calculi: An Update

Success of extracorporeal shock wave lithotripsy and ERCP in symptomatic pancreatic duct stones: a systematic review and meta-analysis

Endoscopic treatment of pancreatic duct stones under direct vision: Revolution or resignation? Systematic review

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