Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: long-term results

Chronic pancreatitis

“…Currently, ESWL is considered as a first-line approach in the treatment of large PD stones, impacted stones, and stones upstream to a stricture [10,39] ( Figure 21.3a-c). PD stones in the head area and the presence of a single stone are important factors associated with the success of ductal clearance after ESWL [40,41]. In addition, intravenous secretin during ESWL appears to aid in ductal clearance by flushing out the stone fragments during ESWL [42].…”

“…The outcome of endoscopic stone removal with or without ESWL is summarized in Table 21.2 [33,40,41,[43][44][45][46][47][48][49][50]. In patients who undergo ERCP with stone removal, complete stone…”

Surgical and Endoscopic Treatment of Pain in Chronic Pancreatitis: A Multidisciplinary Update

“…Dumonceau et al [46 ]reported a significant association between immediate disappearance of pain and complete or partial PD clearance. The independent predictors of long-term pain relapse in this study were a high frequency of pain attacks before treatment, a long duration of disease before treatment, and the presence of a non-papillary stenosis of the main PD [46]. …”

“…The mean effect size (weighted correlation coefficient) was 0.62 for pain and 0.74 for duct clearance [47]. A complete or partial pain relief of 48-91% has been found in patients who underwent ESWL and endoscopy during a follow-up ranging from 6 to 77 months [30,31,32,34,35,37,38,39,40,41,42,43,44,45,46]. Usually, an immediate relief of pain is associated with successful decompression of the main PD (as suggested by decrease in its diameter or stone clearance) [32,35,43,46].…”

“…Furthermore, tolerance, dependency, and adverse events are frequently reported drawbacks of opioid use and have a large impact on the quality of life and social functioning [140]. Likewise, several recent studies have shown that preoperative opioid use predisposes to failure of achieving complete long-term relief of pain after endoscopic and surgical intervention [21,46,87,141,142,143]. Negi et al [87] conclude that patients should be referred for surgery before opiates are needed to relieve pain.…”