Extracorporeal shock wave lithotripsy is safe and effective for geriatric patients with chronic pancreatitis

Abstract

Background and Aim Pancreatic extracorporeal shock wave lithotripsy (P‐ESWL) is a first‐line treatment for chronic pancreatitis (CP) patients with pancreatic stones. However, the performance of P‐EWSL in geriatric patients remains unclear. We aimed to evaluate the safety and efficacy of P‐ESWL for them. Methods This prospective study was conducted in painful CP patients who underwent P‐ESWL. Patients aged over 65 years were included in geriatric group; patients aged under 65 years were assigned to control group. For the long‐term follow‐up investigation, geriatric patients were matched with patients from the control group in a 1:1 ratio. Primary outcomes were complications of P‐ESWL and pain relief. Secondary outcomes included stone clearance, physical and mental health, quality of life score, changes in exocrine and endocrine pancreatic function, and survival. Results From March 2011 to March 2016, P‐ESWL was performed in 1404 patients (72 in the geriatric group and 1332 in the control group). No significant differences were observed in complications of P‐ESWL between the two groups (P = 0.364). Among the 67 (67/72, 93.1%) geriatric patients who underwent follow up for 4.02 years, complete pain relief was achieved in 53 patients, which was not significantly different from that of matched controls (54/70; P = 0.920). The death in the geriatrics was significantly higher (P = 0.007), but none of them were correlated with P‐ESWL. Conclusions P‐ESWL is safe and effective for geriatric CP patients with pancreatic stones. It can promote significant pain relief and stone clearance and improve quality of life and mental and physical health.

Classification of Early-Onset and Late-Onset Idiopathic Chronic Pancreatitis Needs Reconsideration

“…and prospectively enrolled. The detailed information of Changhai CP Database (version number 2.1, Shanghai, China) has been reported in our previous researches [15][16][17][18][19][20][21][22] . The exclusion criteria were as follows: pancreatic cancer diagnosed within 2 years after the diagnosis of CP 23 , groove pancreatitis 24 , autoimmune pancreatitis, and CP patients with distinct etiologies (including alcoholic, abnormal anatomy of pancreatic duct, hereditary, post-traumatic, and hyperlipidemic).…”

Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment

“…6,8,9 P-ESWL disintegration success rate using electromagnetic P-ESWL lithotripters for pancreatic head stones ranges from 10.17% to 81.9%. 6,10,11 A prospective Chinese study reported more fragmented stones among 214 pancreatic head stones. 12 Several studies have indicated that the presence of a single stone and the absence of MPD stricture are prognostic factors for complete stone removal.…”

Management of chronic pancreatitis: recent advances and future prospects

“…Extracorporeal shock wave lithotripsy (ESWL) is a highly effective treatment method for pancreatic stone fragmentation, especially for stones larger than 5 mm. 63 , 64 Previous retrospective cohort studies have shown that ESWL is safe and effective for CP patients, even for those who are geriatric, 65 pediatric, 66 postoperative, 67 or with pancreatic pseudocysts. 68 However, the evidence from RCT on the safety and efficacy of ESWL on pancreatic stones is still of scarcity.…”